Key result
A 31-year-old man with MRSA right-sided infective endocarditis exhibiting vancomycin-creep died despite salvage therapy with daptomycin and ceftaroline and subsequent tricuspid valve surgery.
Case Report (n=1)
MRSA infective endocarditis exhibiting vancomycin-creep carries a poor prognosis, prompting the authors to advocate for early aggressive salvage therapy with daptomycin and ceftaroline.
Portends poor prognosis in vancomycin-creep MRSA IE despite salvage; leaves open optimal early regimens for study.
Right-sided infective endocarditis (RIE) is commonly due to Staphylococcus aureus and often involves the tricuspid valve (TV). A 31-year-old man with prior intravenous drug use presented with substernal pain, cough, dyspnoea and fever. Examination revealed a febrile, tachycardic male with peripheral infective endocarditis stigmata and right-heart failure. Laboratory parameters demonstrated leucocytosis, lactic acidosis and methicillin-resistant S. aureus (MRSA) bacteraemia. Echocardiography demonstrated multiple TV echodensities and chest imaging confirmed septic emboli. The MRSA species demonstrated 'vancomycin-creep', necessitating therapy with daptomycin and ceftaroline. Owing to persistent bacteraemia and septic shock, the patient underwent TV surgery, but continued to have a poor postoperative course with subsequent death. Indications for surgical therapy of RIE are limited to the European guidelines and most data are extrapolated from left-heart disease. MRSA exhibiting vancomycin-creep portends a poorer prognosis and requires aggressive therapy. We advocate the use of ceftaroline salvage therapy with daptomycin, pending further trials.
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Sundaragiri et al. (2015) conducted a case report in Right-sided infective endocarditis due to MRSA exhibiting vancomycin-creep (n=1). Daptomycin and ceftaroline salvage therapy and tricuspid valve surgery was evaluated on Clinical outcome. A 31-year-old man with MRSA right-sided infective endocarditis exhibiting vancomycin-creep died despite salvage therapy with daptomycin and ceftaroline and subsequent tricuspid valve surgery.
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