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Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature
Journal article   Open access   Peer reviewed

Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature

Michael P Stevens and Michael B Edmond
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol.41(8), pp.1134-1142
10/15/2005
DOI: 10.1086/444459
PMID: 16163631
url
https://doi.org/10.1086/444459View
Published (Version of record) Open Access

Abstract

Endocarditis due to vancomycin-resistant enterococci (VRE) is rare, and the literature consists almost exclusively of reports of single cases. We report a case of VRE prosthetic valve endocarditis and review 18 cases of native and prosthetic valve VRE endocarditis reported in the literature. The majority of cases were due to Enterococcus faecium. Nearly all of these infections were hospital acquired, and the vast majority of patients had significant underlying disease processes, including dialysis and transplantation. More than three-quarters of cases were left-sided, and the aortic valve was most commonly involved. Peripheral stigmata of endocarditis were not reported in any of the cases. Approximately 40% of patients developed cardiac complications. Nearly three-quarters of patients survived, despite the difficulties associated with providing bactericidal antimicrobial therapy, and only 4 patients underwent valve replacement. VRE endocarditis is an uncommon nosocomial infection that affects patients with significant comorbid conditions. Most cases are due to E. faecium, and the aortic valve is involved in at least one-half of cases. One-third of patients require surgical treatment. Optimal antimicrobial therapy remains undefined, but an attempt to identify bactericidal combination therapy should be sought.
 Anti-Bacterial Agents - therapeutic use Humans Gram-Positive Bacterial Infections - microbiology Endocarditis, Bacterial - microbiology Vancomycin Resistance Adult Female Enterococcus - drug effects Gram-Positive Bacterial Infections - drug therapy

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