Abstract
BackgroundProsthetic valve endocarditis (PVE) due to methicillin resistant Staphylococcus aureus (MRSA) is a rare disease with significant mortality and morbidity. With the emerging resistance and adverse effect profile of vancomycin which is the standard treatment, there is a compelling necessity of an effective alternative for vancomycin. Linezolid is proved as such an agent for infections caused by MRSA in other sites. However to-date the evidence for successful use of linezolid for MRSA prosthetic valve endocarditis is limited only for few case studies. We here present the third case reported as effective treatment of PVE by MRSA with linezolid and probably the first case reported with successful treatment with linezolid in a patient with multiple complications who is a candidate for surgery in standard guidelines.Case presentationA 45 years old male from Kandy Sri Lanka, who had undergone prosthetic valve replacement 10 years back, presented with prosthetic mitral valve endocarditis caused by MRSA. He failed to respond to vancomycin and cotrimoxazole while sustaining cerebral haemorrhages, as well as life threatening ventricular arrhythmias. Treatment with intravenous linezolid and ciprofloxacin resulted in a complete response with disappearance of the vegetations and sterilization of blood cultures.ConclusionsLinezolid can be considered as a good option for treating PVE by MRSA infections who are not responding to vancomycin and may negate the need for a surgery in patients awaiting an early surgery. Further studies including randomized controlled trials are needed to assess the efficacy of linezolid in PVE due to MRSA.
Highlights
Prosthetic valve endocarditis (PVE) due to methicillin resistant Staphylococcus aureus (MRSA) is a rare disease with significant mortality and morbidity
Linezolid can be considered as a good option for treating PVE by MRSA infections who are not responding to vancomycin and may negate the need for a surgery in patients awaiting an early surgery
Further studies including randomized controlled trials are needed to assess the efficacy of linezolid in PVE due to MRSA
Summary
There are only limited evidence on effective alternatives for treatment of MRSA-PVE. Our case illustrates that linezolid can be considered as an option for vancomycin resistance in treating patients with MRSA-PVE and may negate the need for a valve surgery. These evidence warrant further extensive investigation on this therapeutic approach towards a successful combat against MRSA-PVE. Authors’ contributions CGKA wrote the manuscript and involved in the patient management as a medical registrar. HW is the consultant physician and SB is the senior registrar of the unit who were involved in patient management. All authors read and approved the final manuscript
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