Prosthetic valve endocarditis caused by methicillin-resistant staphylococci
The management of prosthetic valve endocarditis caused by staphylococci is complex – consult an endocarditis team in all cases; see Approach to managing infective endocarditis.
For prosthetic valve endocarditis caused by methicillin-resistant staphylococci in adults and children, use:
vancomycin intravenously for 6 weeks; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults or Intermittent vancomycin dosing for young infants and children. vancomycin vancomycin vancomycin
Because staphylococcal prosthetic valve endocarditis is associated with a high rate of mortality, some international consensus-based guidelines suggest adding gentamicin and rifampicin to vancomycin (based on experimental endocarditis models and limited clinical experience). However, retrospective data on staphylococcal prosthetic valve endocarditis suggest that the addition of rifampicin does not alter rates of one-year survival or relapse, compared with regimens not containing rifampicinLe Bot, 2021. In addition, combination therapy can be associated with significant toxicity, antimicrobial resistance and drug interactions; seek expert advice.
Experience is limited in the treatment of endocarditis caused by S. aureus with reduced susceptibility to vancomycin (vancomycin-intermediate S. aureus [VISA]) or high-level resistance to vancomycin (vancomycin-resistant S. aureus [VRSA]). Treatment options include daptomycin or linezolid – seek expert adviceMunoz, 2021.