trimethoprim--sulfamethoxazole-drug-combination and Endocarditis--Bacterial

Nocardiosis, is a potentially life-threatening disease, especially in immunocompromised individuals where it manifests as a disseminated disease. Infective Endocarditis (IE) is a rare disease with significant morbidity and mortality. Importantly, even though there are scarce data of IE by

Topics: Anti-Bacterial Agents; Endocarditis; Endocarditis, Bacterial; Humans; Nocardia; Trimethoprim, Sulfamethoxazole Drug Combination

Although a variety of microorganisms have caused infective endocarditis, Nocardia species have rarely been reported as a causative agent of the disease. We describe a case of nocardial endocarditis, occurring to a 22-year-old Japanese woman during long-term corticosteroid therapy for adult-onset Still's disease and diagnosed after the rupture of cerebral mycotic aneurysm. Echocardiography showed that the causative organism, isolated from the blood and identified as Nocardia nova with an analysis of 16S ribosomal RNA sequences, affected the posterior papillary muscle of the left ventricle. Nocardia-like organisms were also detected in the pus around the raptured aneurysm. After treatment with imipenem/cilastatin plus amikacin for 3 months followed by oral trimethoprim/sulfamethoxazole for 1 year, no relapse of nocardiosis occurred during a follow-up for 3 years. To our knowledge, the present case is the first reported endocarditis due to N. nova.

Topics: Adult; Endocarditis, Bacterial; Female; Humans; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Cardiac Surgical Procedures; Ceftazidime; Combined Modality Therapy; Device Removal; Drug Resistance, Multiple, Bacterial; Early Diagnosis; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Humans; Levofloxacin; Male; Middle Aged; Prosthesis-Related Infections; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

The management of some serious infections such as infective endocarditis (IE) and bone and joint infections (BJIs) caused by Gram-positive cocci (GPC) is complex and requires great responsiveness and effective antimicrobials with high bioavailability in heart valves or bone tissues. Treatment of these infections requires the use of a higher dosage that may result in increased toxicity or the use of new promising antimicrobials to control the infection. However, use of these new antimicrobials could still bring about new toxicity and resistance. Another approach may be the 'comeback' of old antimicrobials, which is evaluated in this review in the treatment of IE and BJIs caused by GPC.

Topics: Anti-Bacterial Agents; Bone and Bones; Communicable Diseases; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Joints; Osteomyelitis; Prosthesis-Related Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Central Nervous System Infections; Doxycycline; Endocarditis, Bacterial; Enteritis; Gentamicins; Humans; Microscopy, Electron, Transmission; Penicillins; Periodic Acid-Schiff Reaction; Polymerase Chain Reaction; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Vancomycin; Whipple Disease

Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia.. To review evidence of management strategies for S. aureus bacteremia to determine whether transesophageal echocardiography is necessary in all adult cases and what is the optimal antibiotic therapy for methicillin-resistant S. aureus (MRSA) bacteremia.. A PubMed search from inception through May 2014 was performed to identify studies addressing the role of transesophageal echocardiography in S. aureus bacteremia. A second search of PubMed, EMBASE, and the Cochrane Library from January 1990 through May 2014 was performed to find studies addressing antibiotic treatment for MRSA bacteremia. Studies reporting outcomes from antibiotic therapy for MRSA bacteremia were included. All searches, which were limited to English and focused on adults, were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation system with consensus of independent evaluations by at least 2 of the authors.. In 9 studies with a total of 4050 patients, use of transesophageal echocardiography was associated with higher rates of a diagnosis of endocarditis (14%-28%) compared with transthoracic echocardiography (2%-15%). In 4 studies, clinical or transthoracic echocardiography findings did not predict subsequent transesophageal echocardiography findings of endocarditis. Five studies identified clinical or transthoracic echocardiography characteristics associated with low risk of endocarditis (negative predictive values from 93% to 100%). Characteristics associated with a low risk of endocarditis include absence of a permanent intracardiac device, sterile follow-up blood cultures within 4 days after the initial set, no hemodialysis dependence, nosocomial acquisition of S. aureus bacteremia, absence of secondary foci of infection, and no clinical signs of infective endocarditis. Of 81 studies of antibiotic therapy for MRSA bacteremia, only 1 high-quality trial was identified. In that study of 246 patients with S. aureus bacteremia, daptomycin was not inferior to vancomycin or an antistaphylococcal penicillin, each in combination with low-dose, short-course gentamicin (clinical success rate, 44.2% [53/120] vs 41.7% [48/115]; absolute difference, 2.4% [95% CI, -10.2% to 15.1%]).. All adult patients with S. aureus bacteremia should undergo echocardiography. Characteristics of low-risk patients with S. aureus bacteremia for whom transesophageal echocardiography can be safely avoided have been identified. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of S. aureus bacteremia are needed.

Topics: Acetamides; Adult; Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Oxazolidinones; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Large cardiac vegetation carries a poor prognosis and high mortality risk, especially if associated with methicillin-resistant Staphylococcus aureus (MRSA) infection. We share our experience of a rare and complicated large cardiac vegetation which had a favourable outcome with combination antibiotic treatment alone. A 35-year-old HIV-negative, HCV-positive male patient with a previous history of methicillin-susceptible S. aureus endocarditis showed MRSA mitral valve endocarditis with large vegetation, complicated by embolic stroke. The strain was soon identified by PCR but only after culture did the patient receive efficacious antibiotics. A combination of daptomycin plus trimethoprim/sulfamethoxazole (TMP/SMX) was administered for six weeks, followed by a high dosage of TMP/SMX for a further six weeks. Effectiveness of the treatment was demonstrated by the patient's clinical improvement and instrumental evidence of cardiac mitral vegetation clearance. Innovative antibiotic strategies in patient management are needed to fight Staphylococcus aureus endocarditis because strains show varying antimicrobial susceptibility patterns in different geographic areas. Timely initiation of targeted antimicrobial therapy remains a crucial step to reduce morbidity and mortality but culture is crucial for appropriate fine-tuning of antibiotic therapy.

Topics: Adult; Anti-Bacterial Agents; Daptomycin; Drug Therapy, Combination; Endocarditis, Bacterial; Hepatitis C; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Stroke; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis, a zoonotic infection caused by the genus Brucellae, is an ancient condition linked to the consumption of milk and milk products. The disease has global importance due to its impact. Therapeutic options for brucellosis rely mostly on uncontrolled, nonrandomized, non-blinded studies. The choice and duration of therapy are related to patient characteristics and the presence of a focal disease. The usual therapy of acute brucellosis is a combination of doxycycline plus rifampicin for 6 weeks. An aminoglycoside could be substituted for rifampin for the initial week of combination therapy. Other alternatives include a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a fluoroquinolone plus rifampicin. The presence of spondylitis or endocarditis usually indicates that the required treatment will be of a longer duration or a combination of therapy. The article has the discussion of some recent patents related to antibiotic susceptibility and Brucellosis.

Topics: Anti-Bacterial Agents; Bone Diseases, Infectious; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Patents as Topic; Rifampin; Spondylitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease is a multisystemic infection caused by the ubiquitous bacterium Tropheryma whipplei. Immunological host factors enable classical Whipple's disease; however, T. whipplei can be found in three other clinical conditions: healthy colonization, self-limiting infections, and isolated endocarditis. The genetic predisposition of the host rather than the genotype of the bacterium influences the infection. Modern diagnostic methods elucidate the many facets of Whipple's disease. In particular, isolated T. whipplei-induced infective endocarditis can only be diagnosed after valve resection. The sole treatment of Whipple's disease evaluated prospectively comprises intravenous induction therapy with ceftriaxone or meropenem, followed by continuation therapy with oral TMP-SMX. In the case of Immune reconstitution inflammatory syndrome (IRIS) or inflammatory lesions of the CNS in the setting of Whipple's disease, additional treatment with corticosteroids should be considered to avoid severe tissue damage.

Topics: Adrenal Cortex Hormones; Adult; Algorithms; Anti-Bacterial Agents; Biopsy; Carrier State; Ceftriaxone; Central Nervous System Diseases; Child; Diagnosis, Differential; Drug Therapy, Combination; Duodenum; Endocarditis, Bacterial; Gastroscopy; Genetic Predisposition to Disease; Heart Valves; Humans; Immune Reconstitution Inflammatory Syndrome; Meropenem; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Aortic Valve Insufficiency; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; HIV Infections; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mouth; Ofloxacin; Rheumatic Heart Disease; Risk Factors; Stenotrophomonas maltophilia; Substance Abuse, Intravenous; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, non-fermentive, Gram-negative bacillus that is wide spread in the environment. It was considered to be an organism with limited pathogenic potential, which was rarely capable of causing diseases in human other than those who were in debilitated or immunocompromised state. More recent studies have established that Stenotrophomonas maltophilia can behave as a true pathogen. Endocarditis due to this organism is rare, and only 24 cases of Stenotrophomonas maltophilia endocarditis have been reported in the medical literature. Most cases were associated with risk factors, including intravenous drug abuse, dental treatment, infected intravenous devices, and previous cardiac surgery. We present a case with two episodes of Stenotrophomonas maltophilia endocarditis after mitral valve prosthesis implantation, which was treated with antibiotics initially, and a combination of antibiotics and surgery later. To our knowledge, this is the first case of repetitive endocarditis due to Stenotrophomonas maltophilia.

Topics: Adult; Anti-Bacterial Agents; Bioprosthesis; Endocarditis, Bacterial; Gentamicins; Gram-Negative Bacterial Infections; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Recurrence; Stenotrophomonas maltophilia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Stenotrophomonas (Xanthomonas) maltophilia is a rare cause of endocarditis. The extensive resistance of this organism to several antibiotics leaves few options for antimicrobial therapy. In vitro synergism of the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) and ticarcillin/clavulanic acid (TIC/CA) has been demonstrated. To our knowledge, we report the first case of ventriculoatrial cerebrospinal fluid shunt-associated endocarditis due to S. maltophilia. The patient was cured with combination therapy with TMP-SMZ and TIC/CA along with catheter removal. This is also the first report of S. maltophilia endocarditis successfully treated with this antibiotic combination. In a review of the medical literature, only 16 cases of S. maltophilia endocarditis were found. Most patients were intravenous drug users (43.8%) or had either prosthetic heart valves (50%) or an indwelling vascular catheter (18.8%). Although S. maltophilia is usually considered a nosocomial pathogen, about one-half of the cases were community-acquired. Twelve of sixteen patients had left-sided endocarditis. Therapy with a combination of two or more antibiotics was employed in most cases. Seven patients had been given TMP-SMZ therapy, but none had been treated with TIC/CA before. One-half of the patients required cardiac surgery. The overall mortality rate was 33%. Although the optimal antibiotic treatment for S. maltophilia endocarditis remains unknown, the case reported herein reinforces in vitro findings that the combination of TMP-SMZ and TIC/CA may be effective therapy.

Topics: Clavulanic Acids; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Microbial Sensitivity Tests; Middle Aged; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination; Ventriculoperitoneal Shunt; Xanthomonas

Topics: Adult; Child; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Q Fever; Rifampin; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

P. cepacia is reported to be an increasing cause of infection and colonization of patients in hospitals. Historically it is an important contaminant in the pharmaceutical industry. Its nutritional versatility, ability to survive and multiply in water, high intrinsic resistance to antibiotics, and ability to multiply in the majority of traditional disinfectants make it a superb agent for causing nosocomial infection. Recognition of its differences from P. aeruginosa and its ability to contaminate agents used in hospitals is important in proper treatment and infection control.

Topics: Anti-Bacterial Agents; Cross Infection; Disinfectants; Drug Combinations; Drug Contamination; Drug Resistance, Microbial; Endocarditis, Bacterial; Foot Dermatoses; Humans; Pigments, Biological; Pseudomonas; Pseudomonas Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence

We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

Topics: 4-Quinolones; Anti-Infective Agents; Coxiella; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Q Fever; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Tsukamurella spp. are gram-positive rods that can be isolated from the environment in soil and moist areas. In rare instances, they are known to cause infections in immunocompromised hosts. We present the first reported case of Tsukamurella endocarditis in an immunocompromised patient who was successfully treated with a 6-week course of imipenem and trimethoprim-sulfamethoxazole.

Topics: Actinobacteria; Anti-Bacterial Agents; Antineoplastic Agents; Diagnosis, Differential; Endocarditis, Bacterial; Female; Humans; Imipenem; Immunocompromised Host; Lung Neoplasms; Middle Aged; Small Cell Lung Carcinoma; Trimethoprim, Sulfamethoxazole Drug Combination

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.. This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.. The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).. The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.

Topics: Administration, Intravenous; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Administration, Intravenous; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Prosthesis-Related Infections; Salmonella enteritidis; Salmonella Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

This case report details the second described case of Whipple's disease-related thrombocytopenia in the medical literature. Whipple's disease is a rare multisystem infection caused by the actinomycete Tropheryma whipplei, first described by George Whipple in 1907. The key clinical manifestations are weight loss, diarrhoea and malabsorption, but arthralgia and endocarditis are also well described.. A 62-year-old Caucasian female presented with weight loss, anaemia and behavioural changes but denied any abdominal symptoms. Thrombocytopenia subsequently developed rapidly. Bone marrow examination showed abundant megakaryocytes in keeping with peripheral platelet sequestration. In addition, there was significant polyclonal plasmacytosis. She was also found to have a 1.6 cm tricuspid vegetation. The diagnosis was confirmed by presence of foamy macrophages on duodenal biopsy, positive periodic acid-Schiff staining and visualisation of T whipplei actinomycetes on electron microscopy. Tissue PCR performed mid-treatment showed traces of T whipplei DNA. The infection was treated with a 2-week intravenous course of ceftriaxone followed by 12 months of oral co-trimoxazole. The thrombocytopenia and anaemia resolved rapidly with antibiotic therapy, her behaviour returned to normal and she remains clinically well.. This report confirms the association of thrombocytopenia with Whipple's disease, likely due to peripheral platelet sequestration, which resolves rapidly with treatment. In patients with a long history of unintended weight loss, Whipple's disease is a rare but important differential diagnosis as it is ultimately fatal if left untreated.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Middle Aged; Predictive Value of Tests; Risk Factors; Thrombocytopenia; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Duodenum; Endocarditis, Bacterial; Histocytochemistry; Humans; Immunohistochemistry; Male; Microscopy; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Anti-Bacterial Agents; Clindamycin; Endocarditis, Bacterial; Humans; Prospective Studies; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Anticoagulants; Doxycycline; Drug Therapy, Combination; Edema, Cardiac; Endocarditis, Bacterial; Fever; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Polymerase Chain Reaction; Shock, Cardiogenic; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma

Daptomycin-nonsusceptible (DNS) Staphylococcus aureus is found in difficult-to-treat infections, and the optimal therapy is unknown. We investigated the activity of high-dose (HD) daptomycin plus trimethoprim-sulfamethoxazole de-escalated to HD daptomycin or trimethoprim-sulfamethoxazole against 4 clinical DNS methicillin-resistant S. aureus (MRSA) isolates in an in vitro pharmacokinetic/pharmacodynamic model of simulated endocardial vegetations (10(9) CFU/g). Simulated regimens included HD daptomycin at 10 mg/kg/day for 14 days, trimethoprim-sulfamethoxazole at 160/800 mg every 12 h for 14 days, HD daptomycin plus trimethoprim-sulfamethoxazole for 14 days, and the combination for 7 days de-escalated to HD daptomycin for 7 days and de-escalated to trimethoprim-sulfamethoxazole for 7 days. Differences in CFU/g (at 168 and 336 h) were evaluated by analysis of variance (ANOVA) with a Tukey's post hoc test. Daptomycin MICs were 4 μg/ml (SA H9749-1, vancomycin-intermediate Staphylococcus aureus; R6212, heteroresistant vancomycin-intermediate Staphylococcus aureus) and 2 μg/ml (R5599 and R5563). Trimethoprim-sulfamethoxazole MICs were ≤0.06/1.19 μg/ml. HD daptomycin plus trimethoprim-sulfamethoxazole displayed rapid bactericidal activity against SA H9749-1 (at 7 h) and R6212 (at 6 h) and bactericidal activity against R5599 (at 72 h) and R5563 (at 36 h). A ≥8 log(10) CFU/g decrease was observed with HD daptomycin plus trimethoprim-sulfamethoxazole against all strains (at 48 to 144 h), which was maintained with de-escalation to HD daptomycin or trimethoprim-sulfamethoxazole at 336 h. The combination for 14 days and the combination for 7 days de-escalated to HD daptomycin or trimethoprim-sulfamethoxazole was significantly better than daptomycin monotherapy (P < 0.05) and trimethoprim-sulfamethoxazole monotherapy (P < 0.05) at 168 and 336 h. Combination therapy followed by de-escalation offers a novel bactericidal therapeutic alternative for high-inoculum, serious DNS MRSA infections.

Topics: Daptomycin; Diffusion Chambers, Culture; Drug Dosage Calculations; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Models, Cardiovascular; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Clarithromycin; Endocarditis, Bacterial; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Antibiotic treatment, surgical intervention and postoperative antibiotic regimens are recommended for the treatment of brucella endocarditis (BE). Our clinical antibiotic regimens involve a triple antibiotic regimen for treating BE before the operation. The combination of three antibiotics is continued for at least six months and until the titres of the Wright serologic test are diminished to 1:160 levels. In this study, our aim was to evaluate the effects of combined medical and surgical treatments on survival and relapse rates in the periods of mid to late terms. We investigated 13 patients who were treated between January 1993 and June 2009. Our clinical observations led us to use a combination of rifampicin (900 mg twice a day), streptomycin (12 to 16 mg/kg/24 h intramuscularly) and doxycycline (200 mg/kg twice a day); rifampicin, tetracycline (8 mg/kg three times a day) and cotrimoxazole (15 mg/kg twice a day) or rifampicin, doxycycline and cotrimoxazole regimen for treating BE before the operation. This treatment should be continued for at least six months after surgery in order to prevent relapses.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Aortic Valve; Brucellosis; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Recurrence; Survival Analysis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Aortic Valve; Cardiomyopathy, Dilated; Ceftriaxone; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Middle Aged; Reverse Transcriptase Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Ultrasonography; Whipple Disease

Reduced susceptibility to daptomycin has been reported in patients with infections due to methicillin-resistant Staphylococcus aureus (MRSA). Although infections with daptomycin-nonsusceptible (DNS) MRSA are infrequent, optimal therapy of these strains has not been determined. We investigated the killing effects of novel antibiotic combinations with daptomycin (DAP) against two clinical DNS MRSA isolates (SA-684 and R6003) in a 72-h in vitro pharmacokinetic/pharmacodynamic (PK/PD) model with simulated endocardial vegetations (SEV). Simulated regimens included DAP at 6 mg/kg every 24 h (q24h) alone or in combination with trimethoprim-sulfamethoxazole (TMP/SMX) at 160/800 mg q12h, linezolid (LIN) at 600 mg q12h, cefepime (CEF) at 2 g q12h, and nafcillin (NAF) at 4 g q4h. Bactericidal activity was defined as a ≥3-log(10) CFU/g kill. Differences in CFU/g were evaluated between 4 and 72 h by analysis of variance with the Bonferroni post hoc test. DAP MICs were 4 and 2 mg/liter for SA-684 and R6003, respectively. In the PK/PD model, DAP alone was slowly bactericidal, achieving a 3-log(10) kill at 24 and 50 h for SA-684 and R6003, respectively. Against SA-684, DAP plus TMP/SMX, CEF, LIN, or NAF was bactericidal at 4, 4, 8, and 8 h, respectively, and maintained this activity for the 72-h study duration. DAP plus TMP/SMX or CEF exhibited superior killing than DAP alone against SA-684 between 4 and 72 h, and overall this was significant (P < 0.05). Against R6003, DAP plus TMP/SMX was bactericidal (8 h) and superior to DAP alone between 8 and 72 h (P < 0.001). The unique combination of DAP plus TMP/SMX was the most effective and rapidly bactericidal regimen against the two isolates tested and may provide a clinical option to treat DNS S. aureus infections.

Topics: Acetamides; Anti-Infective Agents; Cefepime; Cephalosporins; Daptomycin; Drug Combinations; Endocarditis, Bacterial; Linezolid; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nafcillin; Oxazolidinones; Trimethoprim, Sulfamethoxazole Drug Combination

A 79-year-old woman presented with fever, lethargy and weight loss. Clinically, the patient was confused, frail and had a systolic murmur. Her temperature was 38 °C and she remained persistently febrile. Initial investigations revealed neutrophilia with an elevated C reactive protein level. Multiple peripheral blood cultures grew Achromobacter xylosoxidans, a Gram-negative rod, which is a very rare cause of infection in patients who are immunocompetent. Subsequent transoesophageal echocardiography confirmed endocarditis with obvious vegetations on the mitral valve. The patient was treated with intravenous meropenem and cotrimoxazole in line with microbiology guidance. Surgical intervention in the form of mitral valve replacement was considered, but the patient was felt to be at prohibitive risk. After 6 weeks of intravenous antibiotics, a repeat transoesophageal echocardiogram showed no improvement in the mitral valve vegetation, which had increased in size. At this stage, her clinical course was complicated by major upper gastrointestinal bleeding requiring transfusion, multiorgan failure and ultimately death.

Topics: Achromobacter denitrificans; Aged; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Fatal Outcome; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Meropenem; Mitral Valve; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

A 26-year-old pregnant woman who was an intravenous drug user (IDU) was admitted to our hospital for the treatment of tricuspid valve infective endocarditis (IE) and lung abscesses due to methicillin-resistant Staphylococcus aureus (MRSA). We started to treat her with vancomycin (VCM) alone and then in combination with rifampicin (RFP), but her condition did not improve. Then we added sulfamethoxazole/trimethoprim (SMZ/TMP) to VCM and RFP. After that, she improved rapidly. In Japan, there are very few reports about tricuspid valve IE caused by MRSA in IDUs. This case suggests that the combination of VCM, RFP, and SMZ/TMP may be effective for the treatment of severe MRSA infections.

Topics: Adult; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Lung Abscess; Methicillin-Resistant Staphylococcus aureus; Pregnancy; Pregnancy Complications, Infectious; Pulmonary Embolism; Rifampin; Staphylococcal Infections; Substance Abuse, Intravenous; Tricuspid Valve; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Following an initial response to vancomycin therapy, a patient with meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia developed endocarditis, failed a second course of vancomycin and then failed daptomycin therapy. An increase in the vancomycin minimum inhibitory concentrations of four consecutive MRSA blood isolates from 2 microg/mL to 8 microg/mL was shown by Etest. Population analysis of four successive blood culture isolates recovered over the 10-week period showed that the MRSA strain became progressively less susceptible to both vancomycin and daptomycin. Retrospectively, the macro Etest method using teicoplanin indicated a decrease in vancomycin susceptibility in the second blood isolate. The patient improved after treatment with various courses of trimethoprim/sulfamethoxazole, quinupristin/dalfopristin and linezolid. Early detection of vancomycin-heteroresistant S. aureus isolates, which appeared to have clinical significance in this case, continues to be a challenge for the clinical laboratory. Development of suitable practical methods for this should be given priority. Concurrent development of resistance to vancomycin and daptomycin, whilst rare, must be considered in a patient who is unresponsive to daptomycin following vancomycin therapy.

Topics: Acetamides; Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Resistance, Bacterial; Endocarditis, Bacterial; Humans; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Oxazolidinones; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Virginiamycin

Endocarditis is a rare but life-threatening complication of brucellosis. Its mortality rate has recently been reduced with the use of combined medical and surgical treatment.. Between March 2002 and April 2004, 6 patients with Brucella endocarditis underwent surgery at the Siyami Ersek Cardiovascular Center in Istanbul, Turkey. The diagnosis of Brucellosis was based on the presence of clinical signs and symptoms compatible with brucellosis, serology and/or a positive blood culture. All patients with suspected Brucella endocarditis were studied by echocardiography. The diagnosis of Brucella endocarditis was made in accordance with Duke's criteria.. The most commonly affected valve was the aortic valve (4 patients). Four patients had prosthetic valves because of a previous history of rheumatic fever. In 5 patients, elective surgery was performed. Five patients underwent valve replacement with prosthetic valves, but 1 patient underwent excision of the abscess cavity without valve replacement. There was no operative mortality. All patients continued antibiotic treatment for at least 3 months postoperatively. The median duration of follow-up after surgery was 12 months. During the follow-up period, 1 patient died, while the others remained alive with no recurrences.. Prosthetic valve replacement is a safe procedure in patients with Brucella endocarditis. Surgical interventions combined with triple antibiotic therapy yield good results with no recurrence in the long-term follow-up.

Topics: Adult; Aged; Brucellosis; Combined Modality Therapy; Doxycycline; Endocarditis, Bacterial; Female; Humans; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of methicillin-resistant Staphylococcus aureus endocarditis treated by vancomycin and cotrimoxazole switched to oral linezolid alone with a complete resolution of the vegetation. Two months after discontinuation of treatment, the patient presented a relapse confirmed by pulsed-field gel electrophoresis involving the same linezolid-susceptible strain and rapidly died.

Topics: Acetamides; Anti-Bacterial Agents; Endocarditis, Bacterial; Fatal Outcome; Humans; Linezolid; Male; Methicillin Resistance; Middle Aged; Mitral Valve; Oxazolidinones; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Adult; Anti-Infective Agents; Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Middle Aged; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

A 69-y-old woman with bioprosthetic endocarditis due to Listeria monocytogenes developed an allergic reaction after beginning ampicillin treatment. She was cured with the combination of trimethoprim-sulfamethoxazole, rifampicin and teicoplanin. No immune deficiency was found in the patient.

Topics: Aged; Anti-Bacterial Agents; Drug Hypersensitivity; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Listeria monocytogenes; Listeriosis; Penicillins; Prosthesis-Related Infections; Rifampin; Teicoplanin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Aortic Valve; Brucellosis; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Prosthesis-Related Infections; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis.. Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer > or =20. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3-15 months) after surgery until the titers returned to a level < or =1:160.. There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7+/-13.2%.. Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.

Topics: Adult; Aged; Brucella melitensis; Brucellosis; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Streptomycin; Survival Rate; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Cardiac manifestations of Whipple disease are rarely diagnosed before death.. To describe four patients with endocarditis caused by Tropheryma whippelii who did not have overt gastrointestinal disease.. Case series.. Five hospitals in eastern Switzerland.. Three men and one woman undergoing replacement of insufficient heart valves.. Histologic characteristics of heart valves and intestinal biopsy; broad-range and specific polymerase chain reaction for T. whippelii.. Tropheryma whippelii was found in the heart valves (three aortic valves and one mitral valve) of four patients with culture-negative endocarditis necessitating valve replacement. All patients had arthralgia for different lengths of time. Only one patient had mild gastrointestinal symptoms. Histologic characteristics of intestinal mucosa were normal in all patients, and polymerase chain reaction on intestinal biopsy was positive for T. whippelii in only one patient, who did not have diarrhea. In all patients, arthralgia resolved promptly after institution of antibiotic therapy. Disease did not recur in any patient after prolonged antibiotic therapy with cotrimoxazole.. In patients with culture-negative endocarditis, the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease did not rule out T. whippelii.

Topics: Actinobacteria; Anti-Bacterial Agents; Aortic Valve; Arthralgia; Arthritis; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Mitral Valve; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

A 53-year-old patient had a prosthetic valve (St. Jude Medical 25) 9 years ago because of a Staphylococcus aureus endocarditis with severe aortic regurgitation. An initially mild, progressively more severe, aortic regurgitation then developed as a result of an empty paravalvular abscess cavity, requiring another valve replacement. Fever started on the 3rd postoperative day and persisted despite combined treatment with beta-lactam antibiotics and aminoglycoside.. At first no infectious focus could be identified radiologically or by echocardiography. But transoesophageal echocardiography revealed vegetations in the old abscess cavity. Several blood cultures were negative, while serological tests gave markedly raised antibody titers against Coxiella burnetii.. Assuming Coxiella burnetii endocarditis the patient was given doxycycline, 2 x 100 mg daily and cotrimoxazole, 1 x 960 mg daily. The fever subsided and the vegetations had disappeared after four weeks. Because of the high risk of recurrence the antibiotic treatment was to be continued for two years.. Coxiella burnetii should be considered as a possible cause of fever of unknown origin, especially in patients with existing or operated cardiac valvar defects, when endocarditic vegetations have been demonstrated and several blood cultures have been negative.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Aortic Valve Insufficiency; Coxiella burnetii; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Q Fever; Recurrence; Reoperation; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

A patient with culture-negative endocarditis was diagnosed with Q fever endocarditis based on the results of serological tests and positive leukocyte cultures obtained using conventional viral cultures and the shell vial technique. This case report suggests that isolation of Coxiella burnetii from blood may allow better diagnostic and therapeutical evaluation of patients with Q fever endocarditis. The use of both conventional and shell vial viral cultures is recommended for the isolation of Coxiella burnetii from the blood of patients with apparently culture-negative endocarditis.

Topics: Adult; Bacteriological Techniques; Coxiella burnetii; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Q Fever; Serologic Tests; Trimethoprim, Sulfamethoxazole Drug Combination

Using two strains of Staphylococcus aureus, one susceptible and one heterogeneously resistant to methicillin, for which MICs and MBCs of trimethoprim-sulfamethoxazole (TMP-SMX) were 0.06 and 0.06 micrograms/ml and 0.06 and 0.25 microgram/ml, respectively (concentrations are those of TMP), we studied the efficacies of TMP-SMX and cloxacillin, teicoplanin, and vancomycin for treatment of experimental staphylococcal endocarditis. Rabbits were treated with dosages of TMP-SMX selected to achieve concentrations in serum equivalent to that obtained in humans treated for Pneumocystis carinii pneumonia. The overall mortality rate of rabbits treated with TMP-SMX was 84% at day 3, not different from that of the control groups (P > 0.1). No sterile vegetations were observed to be present in control groups or in animals treated with TMP-SMX. However, 26, 60, and 75% of rabbits treated with teicoplanin, cloxacillin, and vancomycin, respectively, showed sterile vegetations. For methicillin-susceptible S. aureus (MSSA), the mean vegetation counts were not significantly different between the control group and the group treated with TMP-SMX (P > 0.1). For methicillin-resistant S. aureus (MRSA), treatment with TMP-SMX was more effective than no therapy, decreasing the number of organisms in vegetations (P < 0.01). For both strains, therapy with cloxacillin and therapy with teicoplanin or vancomycin were significantly more effective than therapy with TMP-SMX. Despite high concentrations of teicoplanin in serum which exceeded MBCs for staphylococci more than 50 times at the peak and 10 times at the trough, therapy with cloxacillin or vancomycin was superior to therapy with teicoplanin against both MSSA and MRSA. These data do not support the use of TMP-SMX in treatment of endocarditis and other severe staphylococcal infections with high bacterial counts.

Topics: Animals; Anti-Bacterial Agents; Cell Wall; Endocarditis, Bacterial; Methicillin Resistance; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

To assess the potential efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) against serious enterococcal infections, we used a rat enterococcal endocarditis model comparing TMP-SMX therapy (500 mg of TMP plus 2,500 mg of SMX per kg of body weight per day given every 8 h by intragastric gavage) with intravenous ampicillin therapy (1,000 mg/kg per day). Despite concentrations of active drug in serum well in excess of the MIC and MBC, the mean residual vegetation bacterial titer in TMP-SMX-treated rats was similar to that in untreated controls (8.4 +/- 1.1 versus 8.6 +/- 1.3 log10 CFU/g) and significantly higher than that in the ampicillin-treated group (3.6 +/- 1.5 log10 CFU/g; P less than or equal to 0.001). This demonstrates discordance between in vitro activity and in vivo efficacy of TMP-SMX in serious enterococcal infection.

Topics: Ampicillin; Animals; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Infusions, Intravenous; Male; Random Allocation; Rats; Rats, Inbred Strains; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.

Topics: Abscess; Aged; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Escherichia coli Infections; Heart Aneurysm; Humans; Male; Myocardial Infarction; Sulfamethoxazole; Thrombosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Three patients developed Q fever endocarditis on porcine bioprosthetic valves. They had a subacute or chronic course with nonspecific symptoms, enlargement of the liver and spleen, and cardiac failure due to destruction of the cusps, without disruption of the valve ring. High-phase I-specific IgG and IgA antibody titers against Coxiella burnetii were found. C. burnetii was isolated in each patient by inoculating suspensions of valve tissue into a human fetal diploid fibroblast cell line, which was grown as monolayers on slides contained inside rubber-stoppered tube cultures. Patients were treated successfully with doxycycline, cotrimoxazole, and valve replacement and were followed up for periods of 24 to 42 months; no evidence of deterioration was found. The human fetal diploid cell culture may be an expeditious, easy, and safe method to isolate C. burnetii from cardiac valves. Valve replacement seemed necessary to cure prosthetic-valve endocarditis due to C. burnetii infection. Combined therapy with doxycycline and cotrimoxazole may control the disease and prevent reinfection of the homografts replacing the valves.

Topics: Adult; Bioprosthesis; Coxiella; Doxycycline; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Heart Valves; Humans; Male; Q Fever; Reoperation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Five cases of Brucella infective endocarditis are described involving a native aortic valve, two native mitral valves, a mitral valve bioprosthesis, and a ventricular septal defect patch. The diagnosis of Brucella infective endocarditis was established from the clinical features, with a high Brucella serologic titer in each case. Blood and tissue cultures were positive in four of five patients. Two-dimensional echocardiograms demonstrated moderately large vegetations on the three affected native valves and the patch and also revealed the development of vegetation on the mitral bioprosthesis as the disease progressed. All the patients were successfully treated by combined surgical and medical therapy, the latter consisting of co-trimoxazole, tetracycline, and streptomycin/gentamicin for 6 weeks; the affected valves and the ventricular septal defect patch were all replaced. There were no operative deaths and there has been no recurrence of infection to date. One patient died suddenly of an unknown cause 1 year after the operation.

Topics: Adult; Aortic Valve; Brucellosis; Combined Modality Therapy; Drug Combinations; Echocardiography; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Child, Preschool; Drug Combinations; Drug Resistance, Microbial; Endocarditis, Bacterial; Female; Humans; Staphylococcal Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

A 12 year old boy was admitted to hospital with fever, general malaise, cough and peripheral edema. The patient who have had rheumatic heart diseases-mitral insufficiency was found to be in congestive cardiac failure. In blood cultures Staphylococcus aureus and Alpha-hemolytic streptococcus grew. The regimens of Cephalothin-Gentamicin, Methicillin-Tobramicin, to which the organism were sensitive were given intravenously. On these therapy the patient continued to have fever. He was put on Trimethoprim-Sulfomethoxazole intramuscularly. He became afebril for the first time. After two weeks fever recurred. In spite of medical treatment, the infection persisted and the indication for surgery was considered. Mitral valve replacement with a Starr-Edwards prosthesis was carried out. Postoperatively, the patient was treated with TMP-SMZ. For the past 10 months the patient has remained afebril and without evidence of congestive heart failure.

Topics: Child; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Humans; Male; Mitral Valve; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two patients with prosthetic valve endocarditis due to methicillin-resistant Gram-positive cocci (Staphylococcus epidermidis and Micrococcus spp.) are described. They were successfully treated with rifampicin combined first with an aminoglycoside and later with co-trimoxazole or co-trimoxazole plus vancomycin. The addition of rifampicin to these antibiotics resulted in enhanced serum bactericidal activity. High doses of rifampicin (1200-1800 mg) for 7-8 weeks did not cause any serious side-effect. Surgery was not required. During surveillance for more than 2 years endocarditis did not recur.

Topics: Adult; Aminoglycosides; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Methicillin; Microbial Sensitivity Tests; Micrococcus; Middle Aged; Penicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Corynebacterium diphtheriae usually produces an infection limited to the respiratory tract and the organisms rarely invade the blood stream. We report the case of a 6-year-old girl who, 2 months after an unsuccessful repair of a ventricular septal defect, developed septicaemia with non-toxigenic C. diphtheriae. The organism appeared resistant to penicillin in vitro and failed to respond to a course of trimethoprim-sulfamethoxazole to which it was susceptible in the laboratory. A cure was finally achieved using cephalothin and gentamicin, followed by an additional course of ampicillin and amoxicillin. Twelve previously recorded cases of diphtheritic sepsis and endocarditis are reviewed.

Topics: Amoxicillin; Ampicillin; Cephalothin; Child; Diphtheria; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Sepsis; Sulfamethoxazole; Surgical Wound Infection; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

From 1973 to 1983 nine cases of Brucella melitensis infection were hospitalised at the Centre hospitalier universitaire vaudois (CHUV), Lausanne. In each case, the infection was acquired in a Mediterranean country (4 cases in Italy, 2 in Spain, 2 in Portugal and 1 in Greece). In 6 of the cases the disease was acquired by ingestion of dairy products and in 2 cases by direct animal contact. Despite classical initial symptomatology (fever, rigors, weakness), the time from first symptoms to diagnosis varied between 10 days and 5 months. This delay probably explains why 6 of 9 patients were admitted because of septic complications: orchi-epididymitis, arthritis, meningitis and endocarditis. With prolonged antibiotherapy, the evolution was favourable in all cases. The patient who presented with endocarditis required emergency aortic valve replacement. Culture of the valve showed the presence of 10(9) B. melitensis/g of tissue. Cure was achieved by the administration of streptomycin and tetracycline for 6 weeks, followed by cotrimoxazole for one year. These cases show that the diagnosis of Brucella infection is becoming rare in Switzerland. It is often not suspected, and prompt diagnosis is delayed until further complications occur. Serology and blood cultures should be done in every patient presenting with fever after a stay in endemic countries.

Topics: Adult; Aortic Valve Insufficiency; Arthritis, Infectious; Blood; Brucella; Brucellosis; Cerebrospinal Fluid; Child; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis; Streptomycin; Sulfamethoxazole; Synovial Fluid; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Cefotaxime; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Middle Aged; Serratia marcescens; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Q Fever; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Despite a worldwide distribution of Coxiella burnetii, only single cases of Q fever endocarditis have been reported outside Great Britain and Australia. We present 10 patients; five were female, only four had a history of environmental exposure, and the mitral valve was involved as commonly as the aortic stenosis, and three patients had a prosthetic valve. We confirm the importance of hepatic involvement, thrombocytopenia and hypergammaglobulinemia as diagnostic features. Diagnosis was established by finding and elevated complement-fixing antibody to Phase I C. burnetii antigen. Tetracycline, with or without lincomycin or cotrimoxazole, was used in nine patients, and one patient received cotrimoxazole as as the sole antibiotic agent. Optimal duration of therapy is unknown. In one patient, relapse followed when treatment was stopped after 18 months. Valve replacement was necessary in five patients, because of hemodynamic problems. Five patients died, and the means survival is 36 months with a range of five to 66 months. We suggest that Q fever endocarditis is frequently missed, and we recommend clinicians to consider the diagnosis in all cases of culture-negative endocarditis.

Topics: Adult; Antibodies, Bacterial; Coxiella; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Ireland; Lincomycin; Male; Middle Aged; Q Fever; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination