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Prosthetic Valve Endocarditis Caused by Staphylococcus epidermidisDevelopment of Rifampin Resistance During Vancomycin and Rifampin Therapy
Bruce Chamovitz, MD;
Richard E. Bryant, MD;
David N. Gilbert, MD;
Alan I. Hartstein, MD
JAMA. 1985;253(19):2867-2868.
Abstract
Development of rifampin-resistant Staphylococcus epidermidis was documented in three patients receiving vancomycin and rifampin therapy for prosthetic valve endocarditis. The minimum inhibitory concentrations and minimum bactericidal concentrations of rifampin for the original three isolates were 0.4 µg/mL or less. Organisms cultured during relapse or prosthetic valve replacement had minimum inhibitory concentrations of rifampin that were 12.5, 50, and greater than 100 µg/mL, respectively. Surgical intervention was necessary in all patients. One died, and one required a second prosthetic valve placement. The patients were treated with vancomycin plus aminoglycoside following identification of rifampin resistance. These observations suggest that vancomycin and rifampin may not be adequate therapy for prosthetic valve endocarditis caused by S epidermidis.
(JAMA 1985;253:2867-2868)
Author Affiliations
From the Department of Medicine and Infectious Disease Division (Drs Chamovitz, Bryant, and Hartstein), Oregon Health Science University; and Providence Medical Center (Dr Gilbert), Portland.
Footnotes
Presented in part at the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami, Oct 4-6, 1982.
Reprint requests to Medical Center of Beaver County. 1000 Dutch Ridge Rd, Beaver, PA 15009 (Dr Chamovitz).
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