Abstract
IntroductionStaphylococcus aureus is the most common cause of acute infective endocarditis.Recent reports have described heteroresistance to vancomycin associated with methicillin-resistant Staphylococcus aureus. We present the first case report in Argentina of the failure of treatment with vancomycin in endocarditis caused by methicillin-susceptible Staphylococcus aureus containing subpopulations with reduced susceptibility to vancomycin.Case presentationWe report the case of a 66-year-old Hispanic man with infective endocarditis complicated by septic emboli in the lumbosacral spine and the left iliopsoas muscle. This disease was caused by methicillin-susceptible Staphylococcus aureus containing subpopulations with reduced susceptibility to vancomycin. He was initially treated with cephalothin and gentamicin but developed a rash caused by beta-lactams and interstitial nephritis. For that reason, the treatment was subsequently switched to vancomycin but he failed to respond. The infection resolved after administration of vancomycin in combination with gentamicin and rifampin.ConclusionOur case report provides important evidence for the existence of subpopulations of methicillin-susceptible Staphylococcus aureus that have reduced susceptibility to vancomycin which would account for treatment failure. Our case raises an alert about the existence of these strains and highlights the need to determine the vancomycin minimum inhibitory concentration of Staphylococcus aureus to screen for the presence of strains that have reduced vancomycin susceptibility at different infection sites.
Highlights
Staphylococcus aureus is the most common cause of acute infective endocarditis
We present the first case report in Argentina of the failure of vancomycin treatment for endocarditis caused by methicillin-susceptible S. aureus (MSSA) containing subpopulations with reduced susceptibility to vancomycin
Case presentation We report the case of a 66-year-old Hispanic man with a history of diabetes, psoriasis, smoking, alcoholism, hospitalization in the previous year due to upper gastrointestinal bleeding (UGB), gastric ulcer and bacteremic lower limb cellulitis caused by MSSA, who received intravenous cephalothin for 14 days
Summary
Our case report provides important evidence for the existence of subpopulations of methicillinsusceptible Staphylococcus aureus that have reduced susceptibility to vancomycin which would account for treatment failure. Our case raises an alert about the existence of these strains and highlights the need to determine the vancomycin minimum inhibitory concentration of Staphylococcus aureus to screen for the presence of strains that have reduced vancomycin susceptibility at different infection sites
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