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Treatment of Staphylococcus aureus Prosthetic Valve Endocarditis
The American Journal of Medicine (2007) 120, e9
LETTER Treatment of Staphylococcus aureus Prosthetic Valve Endocarditis
in this study. Further studies are necessary to establish the effectiveness of triple antibiotic therapy versus surgical therapy in S. aureus PVE.
To the Editor: We read with interest the recent article by Sohail et al1 concerning the management of Staphylococcus prosthetic valve endocarditis (PVE). This infection causes difficult management issues for patients and vexing therapeutic challenges for their health care providers. The study was a retrospective review, which definitely contributed to its limitation. In addition, the most recent guidelines for treatment of PVE were followed in less than 17% of cases. Triple antibiotic therapy (6 weeks of beta lactam or vancomycin plus rifampin and 2 weeks of aminoglycoside) has been recommended by the American Heart Association and European Society of Cardiology for the treatment of PVE caused by S. aureus.2,3 Recent studies showed that patients receiving combination therapy were 5.9 times more likely to be culture-negative than those receiving monotherapy and that those treated for more than 14 days were more likely to be culture-negative than those treated for 14 days or less.4 Unfortunately in this study, less than 50% of patients in the medically treated group were given dual therapy, and less than 17% received appropriate triple antibiotic treatment. In addition, methicillin-resistant S. aureus is increasingly more common, whereas all organisms were methicillin-sensitive
0002-9343/$ -see front matter © 2007 Elsevier Inc. All rights reserved.
Ali Hassoun, MD Alabama Infectious Diseases Center Huntsville
doi:10.1016/j.amjmed.2006.02.021
References 1. Sohail M, Martin K, Wilson W, et al. Medical versus surgical management of Staphylococcus aureus prosthetic valve endocarditis. Am J Med. 2006;119:147. 2. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111(23):e394-434. 3. Horstkotte D, Follath F, Gutschik E, et al. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology. Eur Heart J. 2004;25(3):267-276. 4. Drinkovic D, Morris AJ, Pottumarthy S, MacCulloch D, West T. Bacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis. J Antimicrob Chemother. 2003;52(5): 820-825. Epub 2003 Sep 30.
LETTER Treatment of Staphylococcus aureus Prosthetic Valve Endocarditis
in this study. Further studies are necessary to establish the effectiveness of triple antibiotic therapy versus surgical therapy in S. aureus PVE.
To the Editor: We read with interest the recent article by Sohail et al1 concerning the management of Staphylococcus prosthetic valve endocarditis (PVE). This infection causes difficult management issues for patients and vexing therapeutic challenges for their health care providers. The study was a retrospective review, which definitely contributed to its limitation. In addition, the most recent guidelines for treatment of PVE were followed in less than 17% of cases. Triple antibiotic therapy (6 weeks of beta lactam or vancomycin plus rifampin and 2 weeks of aminoglycoside) has been recommended by the American Heart Association and European Society of Cardiology for the treatment of PVE caused by S. aureus.2,3 Recent studies showed that patients receiving combination therapy were 5.9 times more likely to be culture-negative than those receiving monotherapy and that those treated for more than 14 days were more likely to be culture-negative than those treated for 14 days or less.4 Unfortunately in this study, less than 50% of patients in the medically treated group were given dual therapy, and less than 17% received appropriate triple antibiotic treatment. In addition, methicillin-resistant S. aureus is increasingly more common, whereas all organisms were methicillin-sensitive
0002-9343/$ -see front matter © 2007 Elsevier Inc. All rights reserved.
Ali Hassoun, MD Alabama Infectious Diseases Center Huntsville
doi:10.1016/j.amjmed.2006.02.021
References 1. Sohail M, Martin K, Wilson W, et al. Medical versus surgical management of Staphylococcus aureus prosthetic valve endocarditis. Am J Med. 2006;119:147. 2. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111(23):e394-434. 3. Horstkotte D, Follath F, Gutschik E, et al. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology. Eur Heart J. 2004;25(3):267-276. 4. Drinkovic D, Morris AJ, Pottumarthy S, MacCulloch D, West T. Bacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis. J Antimicrob Chemother. 2003;52(5): 820-825. Epub 2003 Sep 30.