title: Prosthetic biologic valve endocarditis caused by a vancomycin-resistant (vanA) Enterococcus faecalis: case report.
abstract: We recently observed (February 1999) a 68-year old patient with endocarditis on a prosthetic biologic valve caused by a vancomycin-resistant Enterococcus faecalis. Broth dilution tests showed susceptibility to ampicillin (MIC=0.5 microg/ml), no high resistance to aminoglycosides (MIC for gentamicin <500 microg/ml) and resistance to vancomycin (MIC >256 microg/ml) and teicoplanin (MIC >16 microg/ml). A PCR assay detected vanA gene in this strain. A transthoracic echocardiogram did not show valvular vegetations. A possible endocarditis was diagnosed and the patient received ampicillin for 8 weeks and gentamicin for 6 weeks. The patient remained afebrile after a 4-month follow-up when he underwent surgical replacement of the dysfunctional bioprosthetic valve. Mitral valve was sterile on culture, but histology confirmed the diagnosis of previous endocarditis. This is the third case of endocarditis caused by vancomycin-resistant E. faecalis reported to date.
authors: Clinica Medica 3, Dipartimento di Medicina Clinica, Università La Sapienza Rome, Italy. pcarfagna@tin.it
authors: P
authors: P
authors: Carfagna
authors: A
authors: A
authors: Tarasi
authors: M
authors: M
authors: Cassone
authors: M F
authors: MF
authors: Del Grosso
authors: G
authors: G
authors: Bianco
authors: M
authors: M
authors: Venditti
mesh_terms: D000368:Aged; D001426:Bacterial Proteins / Q000502:physiology; D019729:Carbon-Oxygen Ligases / Q000502:physiology; D004697:Endocarditis, Bacterial / Q000382:microbiology*; D013293:Enterococcus faecalis; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology*; D006349:Heart Valve Diseases / Q000382:microbiology*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000382:microbiology; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D020713:Vancomycin Resistance / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases