title: Staphylococcus haemolyticus endocarditis: clinical and microbiologic analysis of 4 cases.
abstract: Only 3 cases of infective endocarditis (IE) due to methicillin-resistant Staphylococcus haemolyticus (MRSH) have been reported in English literature. Here we report 4 cases of IE due to MRSH encountered in a single university hospital. Population analysis of the strains was performed to assess the presence of vancomycin/teicoplanin heteroresistant subpopulations. Pulsed-field gel electrophoresis was used for molecular typing of isolates. IE was defined in 3 cases as health care associated, and in 1 case, as community acquired. A causative strain was lost. Two strains were heteroresistant to teicoplanin, and 1 also to vancomycin. Genome macrorestriction profile studies demonstrated that 2 MRSH isolates belonged to clones A and E, possessing a class C1 mecDNA, whereas 1 clone was sporadic. All patients were treated with vancomycin plus rifampin. Two patients were cured with antibiotic therapy alone, 1 patient needed surgery, and 1 patient died. Methicillin-resistant multiresistant S. haemolyticus may represent a difficult-to-treat cause of both community and nosocomially acquired IE.
authors.affiliation: Department of Clinical Medicine, Policlinico Umberto I, University of Rome La Sapienza, 00185 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.forename: Floriana
authors.initials: F
authors.lastname: Campanile
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.forename: Sonia
authors.initials: S
authors.lastname: Borbone
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D001021:Aortic Valve / Q000382:microbiology*; D016470:Bacteremia / Q000382:microbiology; D004359:Drug Therapy, Combination; D016521:Electrophoresis, Gel, Pulsed-Field; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology*; D041162:Staphylococcus haemolyticus / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D012293:Rifampin