title: Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus.
abstract: BACKGROUND
  Methicillin-resistant S. aureus (MRSA) with low susceptibility to glycopeptides is uncommon.
  
  
  METHODS
  The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE) by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin--rifampicin--cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin.
  
  
  CONCLUSIONS
  The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin.
authors.affiliation: Department of Internal Medicine, C. Magati Hospital, Via Martiri della libertà 8, 42019 Scandiano RE, Italy. GIUSEPPE.CHESI@ausl.re.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chesi
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Gambarati
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Boni
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D011859:Radiography; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D019966:Substance-Related Disorders; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000382:microbiology; D014463:Ultrasonography; D014769:Virginiamycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C062940:quinupristin-dalfopristin