1/7. endocarditis caused by methicillin-resistant staphylococcus aureus: treatment failure with linezolid.We describe 2 cases of endocarditis caused by methicillin-resistant staphylococcus aureus that failed to respond to intravenous linezolid therapy but were successfully treated with trimethoprim-sulfamethoxazole plus gentamicin and vancomycin plus rifampin.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
2/7. vancomycin treatment failure associated with heterogeneous vancomycin-intermediate Staphylococcus aureus in a patient with endocarditis and in the rabbit model of endocarditis.Heterogeneous resistance to vancomycin is thought to precede emergence of intermediate susceptibility to vancomycin in Staphylococcus aureus, but the clinical significance of heterogeneous resistance is unknown. Paired S. aureus isolates from a patient with endocarditis who relapsed after vancomycin treatment were tested for heterogeneous resistance to vancomycin. The pretreatment and the relapse clinical isolates (strains SF1 and SF2, respectively) were genotyped by pulsed-field gel electrophoresis. Susceptibility to vancomycin was assessed by the broth dilution method, population analysis, and time-kill studies and in the rabbit model of endocarditis. Strains SF1 and SF2 had similar genotypes, and the vancomycin MICs for the strains were vancomycin. vancomycin eradicated SF1 in the rabbit model of endocarditis, while SF2 persisted at pretreatment levels. vancomycin treatment failure in this patient with endocarditis was attributable to heterogeneous resistance to vancomycin.- - - - - - - - - - ranking = 1.25keywords = treatment failure (Clic here for more details about this article) |
3/7. Infective endocarditis due to abiotrophia defectiva: a report of two cases.BACKGROUND AND AIM OF THE STUDY: endocarditis due to abiotrophia sp. is rare and often associated with negative blood cultures. The rates of treatment failure, infection relapse and mortality are higher than in endocarditis caused by other viridans streptococci. methods: A retrospective review of A. defectiva endocarditis in a patient with prosthetic aortic valve and in a patient with marfan syndrome was performed. RESULTS: A. defectiva, susceptible to penicillin (MIC 0.064 mg/l and 0.016 mg/l, respectively) was isolated from blood cultures of both patients. Treatment with penicillin and gentamicin was started in both patients. Since the first patient developed a macular rash and leukopenia, penicillin was substituted with ceftriaxone. Both patients responded well to antibiotic treatment, did not need prosthetic valve insertion or reinsertion, and were without any sequelae at one year follow up. CONCLUSION: Standard treatment of bacterial endocarditis with penicillin and gentamicin was effective in both patients. In contrast to previous reports, the present patients had a favorable outcome on completion of treatment and at one-year follow up.- - - - - - - - - - ranking = 0.25keywords = treatment failure (Clic here for more details about this article) |
4/7. daptomycin cure after cefazolin treatment failure of Methicillin-sensitive Staphylococcus aureus (MSSA) tricuspid valve acute bacterial endocarditis from a peripherally inserted central catheter (PICC) line.Right-sided acute bacterial endocarditis (ABE) is an infrequent complication of central intravenous (IV) lines. We report a case of methicillin-sensitive Staphylococcus aureus tricuspid valve (TV) ABE related to a peripherally inserted central catheter line (PICC). patients with right-sided ABE present with symptoms of fever and chills, and symptoms and signs of pulmonary emboli. In the patient presented, the PICC line was removed and high-dose cefazolin therapy, 2 g (IV) every 8 hours, was initiated. Although the patient's blood cultures became negative during the third week of cefazolin therapy, her erythrocyte sedimentation rate and teichoic acid antibody titers remained high. Pulmonary emboli developed. A large TV vegetation (1 x 2 cm) remained unchanged after 4 weeks of cefazolin therapy. For these reasons, cefazolin treatment was considered a treatment failure. Therapy with daptomycin was initiated at a dose of 6 mg/kg (IV) every 24 hours. During daptomycin therapy, the patient's erythrocyte sedimentation rate and teichoic acid antibody titers gradually returned to normal. Repeat transthoracic echocardiograph revealed the TV vegetation was gone and the methicillin-sensitive Staphylococcus aureus ABE was cured with daptomycin. We conclude daptomycin is a rapidly bactericidal antistaphylococcal antibiotic reliably effective even when other usually effective antistaphylococcal antibiotics have failed.- - - - - - - - - - ranking = 1.25keywords = treatment failure (Clic here for more details about this article) |
5/7. Failure of treatment with teicoplanin at 6 milligrams/kilogram/day in patients with Staphylococcus aureus intravascular infection. The Infectious Diseases Consortium of oregon.patients with blood cultures positive for gram-positive cocci were enrolled in a prospective randomized double-blind comparative trial of vancomycin at 15 mg/kg every 12 h versus teicoplanin at 6 mg/kg every 12 h for three doses and then 6 mg/kg every 24 h. A total of 54 patients were randomized, and 40 were evaluable. Of the 40, 9 had infection of indwelling vascular catheters. Four infections were due to Staphylococcus aureus, and five were due to staphylococcus epidermidis. In concert with catheter removal, all patients were treated successfully, regardless of which drug they were taking. Of 31 patients without an indwelling catheter, 19 were infected with S. aureus, and 12 of the 19 had either endocarditis or mycotic aneurysm. Six of eight patients given teicoplanin failed treatment, as opposed to one of four patients given vancomycin (P = 0.14). Of greater concern, four of four patients with left-sided endocarditis or mycotic aneurysm failed to recover when given teicoplanin, as opposed to one of three patients given vancomycin (P = 0.07). Although not quite statistically significant, the unexpectedly high number of treatment failures with teicoplanin resulted in a decision to discontinue patient enrollment. It is suggested that future trials explore the efficacy of larger doses of teicoplanin.- - - - - - - - - - ranking = 0.25keywords = treatment failure (Clic here for more details about this article) |
6/7. pseudomonas endocarditis: cure with carbenicillin and polymyxin b.A case of pseudomonas endocarditis cured with carbenicillin and polymyxin b is described. Initially, this patient was considered a medical treatment failure when a full course of carbenicillin and gentamicin failed to effect a cure. The importance of monitoring therapy with appropriate laboratory tests is stressed.- - - - - - - - - - ranking = 0.25keywords = treatment failure (Clic here for more details about this article) |
7/7. endocarditis caused by streptococcus morbillorum.Although patients with nutritionally variant streptococcal endocarditis have been reported in recent years, the specific clinical features of this disease have not been well characterized. We report here the clinical and laboratory features of a particularly unusual case of persistent bacteremia caused by streptococcus morbillorum , one of the nutritionally variant streptococci. The patient was successfully treated with a combination of penicillin and rifampin after two treatment failures. We also review cases of nutritionally variant streptococcal endocarditis published in the English literature since 1971, in an attempt to understand some difficulties encountered in diagnosing and treating this type of endocarditis.- - - - - - - - - - ranking = 0.25keywords = treatment failure (Clic here for more details about this article) |