An Unusual Occurrence of Methicillin Resistant Staphylococcal Endocarditis with Vancomycin Creep Phenomenon – A Therapeutic Challenge

Sneha, S and Venishetty, Shanthan and Seshadri, Shubha and Rao, Sudhakar M and Mukhopadhyay, Chiranjay (2016) An Unusual Occurrence of Methicillin Resistant Staphylococcal Endocarditis with Vancomycin Creep Phenomenon – A Therapeutic Challenge. Journal of Clinical and Diagnostic Research, 10 (12). pp. 12-14. ISSN 0973-709X

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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

Item Type: Article
Uncontrolled Keywords: Daptomycin; Minimum inhibitory concentration; Mitral valve endocarditis
Subjects: Medicine > KMC Manipal > Cardiology
Medicine > KMC Manipal > Medicine
Medicine > KMC Manipal > Microbiology
Depositing User: KMC Library
Date Deposited: 09 Jan 2018 09:32
Last Modified: 09 Jan 2018 09:32
URI: http://eprints.manipal.edu/id/eprint/147773

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