title: Staphylococcus lugdunensis bacteremia and endocarditis treated with cefazolin and rifampin.
abstract: OBJECTIVE
  This case report describes the treatment of a rare infection caused by Staphylococcus lugdunensis with cefazolin and rifampin.
  
  
  CONCLUSIONS
  A 48-year-old man with significant comorbidities was admitted to our institution with complaints of malaise, shortness of breath, and vague persistent pain. He was diagnosed with S. lugdunensis infective endocarditis and was treated with cefazolin continuous infusion for 10 days without resolution of bacteremia. As surgical intervention was deemed inappropriate, rifampin was added to the treatment regimen for its antibiofilm activity. After rifampin initiation, resolution of bacteremia was rapidly achieved. Subsequent blood cultures remained negative, and the patient was discharged home in stable condition to complete six weeks of i.v. cefazolin and rifampin therapy. The patient continued treatment, as documented by the infusion center, weekly for five weeks. The patient was rehospitalized during his sixth week of treatment due to impending respiratory failure, whereupon he was intubated and admitted to the intensive care unit. The patient's cardiac status gradually worsened over the following days, and he ultimately died. Blood cultures from days 1 and 2 of hospitalization revealed no bacterial growth at five days.
  
  
  CONCLUSIONS
  Cefazolin and rifampin therapy in a hospitalized patient with bacteremia and aortic valve endocarditis caused by S. lugdunensis resulted in rapid eradication of the bacteremia. After more than five weeks of cefazolin-rifampin treatment, the patient was rehospitalized with worsening cardiac function and died. Blood cultures during the second admission were negative.
authors.affiliation: Bryson Duhon, Pharm.D., BCPS, is Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, and Clinical Pharmacist, University Health System (UHS), San Antonio, TX. Steven Dallas, Ph.D., D(ABMM), MT(ASCP)SM, is Assistant Professor, Department of Clinical Laboratory Sciences, University of Texas Health Science Center (UTHSC) at San Antonio, San Antonio, and Director, Microbiology Laboratory, UHS. Sadie T. Velasquez, M.D., is Assistant Professor of Medicine, Department of Medicine, Division of Hospital Medicine, UTHSC at San Antonio. Elizabeth Hand, Pharm.D., BCPS, is Clinical Pharmacist, UHS, and Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin. duhon@uthscsa.edu.
authors.forename: Bryson
authors.initials: B
authors.lastname: Duhon
authors.affiliation: Bryson Duhon, Pharm.D., BCPS, is Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, and Clinical Pharmacist, University Health System (UHS), San Antonio, TX. Steven Dallas, Ph.D., D(ABMM), MT(ASCP)SM, is Assistant Professor, Department of Clinical Laboratory Sciences, University of Texas Health Science Center (UTHSC) at San Antonio, San Antonio, and Director, Microbiology Laboratory, UHS. Sadie T. Velasquez, M.D., is Assistant Professor of Medicine, Department of Medicine, Division of Hospital Medicine, UTHSC at San Antonio. Elizabeth Hand, Pharm.D., BCPS, is Clinical Pharmacist, UHS, and Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin.
authors.forename: Steven
authors.initials: S
authors.lastname: Dallas
authors.affiliation: Bryson Duhon, Pharm.D., BCPS, is Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, and Clinical Pharmacist, University Health System (UHS), San Antonio, TX. Steven Dallas, Ph.D., D(ABMM), MT(ASCP)SM, is Assistant Professor, Department of Clinical Laboratory Sciences, University of Texas Health Science Center (UTHSC) at San Antonio, San Antonio, and Director, Microbiology Laboratory, UHS. Sadie T. Velasquez, M.D., is Assistant Professor of Medicine, Department of Medicine, Division of Hospital Medicine, UTHSC at San Antonio. Elizabeth Hand, Pharm.D., BCPS, is Clinical Pharmacist, UHS, and Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin.
authors.forename: Sadie T
authors.initials: ST
authors.lastname: Velasquez
authors.affiliation: Bryson Duhon, Pharm.D., BCPS, is Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, and Clinical Pharmacist, University Health System (UHS), San Antonio, TX. Steven Dallas, Ph.D., D(ABMM), MT(ASCP)SM, is Assistant Professor, Department of Clinical Laboratory Sciences, University of Texas Health Science Center (UTHSC) at San Antonio, San Antonio, and Director, Microbiology Laboratory, UHS. Sadie T. Velasquez, M.D., is Assistant Professor of Medicine, Department of Medicine, Division of Hospital Medicine, UTHSC at San Antonio. Elizabeth Hand, Pharm.D., BCPS, is Clinical Pharmacist, UHS, and Clinical Assistant Professor, Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hand
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002437:Cefazolin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D017809:Fatal Outcome; D006801:Humans; D007262:Infusions, Intravenous; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D057787:Staphylococcus lugdunensis
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin; D012293:Rifampin