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To the Editor: Antimicrobial resistance is an increasing problem in the treatment of infections due to Streptococcus pneumoniae.¹ Such resistance has also recently been reported in the United States among the viridans group of streptococci, especially Streptococcus mitis.² We report a case of subacute bacterial endocarditis in a child, resulting from an infection caused by S mitis that was fully resistant to penicillin and ceftriaxone.

Report of a Case

A 22-month-old black male with a known history of a perimembranous ventricular septal defect was admitted to our hospital with a 10-day history of fever and irritability. The patient had otherwise been healthy. Both blood cultures drawn on admission grew S mitis. The sensitivity analyses showed a minimal inhibitory concentration (MIC) to penicillin of 4 µg/mL, an MIC to ceftriaxone of 4 µg/mL, and an MIC to vancomycin of 0.5 µg/mL or less. Transthoracic echocardiography revealed a large vegetation on the tricuspid . . . [Full Text of this Article]

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