An unusual occurrence of methicillin resistant staphylococcal endocarditis with vancomycin creep phenomenon – A therapeutic chall

S. Sneha, Shanthan Venishetty, Shubha Seshadri, M. Sudhakar Rao, Chiranjay Mukhopadhyay

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Infective endocarditis by Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia is a common association and carries a high mortality. However, rising Minimum Inhibitory Concentrations (MICs) for vancomycin amongst MRSA strains is an emerging threat which carries poor prognosis and higher mortality. Here we report a case of 41-year-old young non-addict gentleman presenting with fever of 3 days duration following recovery from an acute kidney injury necessitating haemodialysis. Systemic examination revealed signs of mitral regurgitation and left sided cerebellar signs. Laboratory investigations revealed anaemia, MRSA bacteraemia and transthoracic echocardiogram showed a mitral valve vegetation. He was diagnosed with MRSA mitral valve endocarditis with acute left cerebellar infarct. He was initially treated with intravenous vancomycin based on MIC at the dose of one gram every twelfth hourly. As the MRSA strain was shown to demonstrate a vancomycin creep phenomemon along with worsening clinical condition of the patient, treatment was changed to intravenous daptomycin at dose of 9mg/kg as per blood culture and sensitivity pattern which was administered for 6 weeks. Following initiation of daptomycin patient became afebrile and vegetations reduced in size and finally disappeared.

Original languageEnglish
Pages (from-to)OD12-OD14
JournalJournal of Clinical and Diagnostic Research
Volume10
Issue number12
DOIs
Publication statusPublished - 01-12-2016

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Methicillin Resistance
Methicillin
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Endocarditis
Creep
Daptomycin
Microbial Sensitivity Tests
Bacteremia
Mitral Valve
Patient treatment
Therapeutics
Mortality
Mitral Valve Insufficiency
Acute Kidney Injury
Renal Dialysis
Anemia
Blood
Fever
Recovery

All Science Journal Classification (ASJC) codes

  • Clinical Biochemistry

Cite this

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An unusual occurrence of methicillin resistant staphylococcal endocarditis with vancomycin creep phenomenon – A therapeutic chall. / Sneha, S.; Venishetty, Shanthan; Seshadri, Shubha; Sudhakar Rao, M.; Mukhopadhyay, Chiranjay.

In: Journal of Clinical and Diagnostic Research, Vol. 10, No. 12, 01.12.2016, p. OD12-OD14.

Research output: Contribution to journalArticle

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