title: Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep phenomenon.
abstract: Right-sided infective endocarditis (RIE) is commonly due to Staphylococcus aureus and often involves the tricuspid valve (TV). A 31-year-old man with prior intravenous drug use presented with substernal pain, cough, dyspnoea and fever. Examination revealed a febrile, tachycardic male with peripheral infective endocarditis stigmata and right-heart failure. Laboratory parameters demonstrated leucocytosis, lactic acidosis and methicillin-resistant S. aureus (MRSA) bacteraemia. Echocardiography demonstrated multiple TV echodensities and chest imaging confirmed septic emboli. The MRSA species demonstrated 'vancomycin-creep', necessitating therapy with daptomycin and ceftaroline. Owing to persistent bacteraemia and septic shock, the patient underwent TV surgery, but continued to have a poor postoperative course with subsequent death. Indications for surgical therapy of RIE are limited to the European guidelines and most data are extrapolated from left-heart disease. MRSA exhibiting vancomycin-creep portends a poorer prognosis and requires aggressive therapy. We advocate the use of ceftaroline salvage therapy with daptomycin, pending further trials.
authors.affiliation: Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Pranathi Rao
authors.initials: PR
authors.lastname: Sundaragiri
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Toufik Mahfood
authors.initials: TM
authors.lastname: Haddad
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Esterbrooks
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D017576:Daptomycin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004697:Endocarditis, Bacterial / Q000382:microbiology*; D017809:Fatal Outcome; D006349:Heart Valve Diseases / Q000382:microbiology*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008943:Mitral Valve; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy*; D014261:Tricuspid Valve; D014640:Vancomycin / Q000494:pharmacology; D000097583:Ceftaroline
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017576:Daptomycin; D014640:Vancomycin; D000097583:Ceftaroline