Skip Navigation

European Journal of Echocardiography 2006 7(5):405-406; doi:10.1016/j.euje.2006.02.010
This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Wiper, A. J.
Right arrow Articles by Roberts, D. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wiper, A. J.
Right arrow Articles by Roberts, D. H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Copyright © 2006, The European Society of Cardiology

MRSA endocarditis – Postcardiac surgery

Andrew James Wiper*, Matthias Schmitt, Ian Schofield and David H. Roberts

Blackpool Victoria Hospital, Cardiology, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK

Received 4 December 2005; received in revised form 12 February 2006; accepted after revision 28 February 2006.

* Tel.: +44 01772 866005. a_wiper{at}yahoo.com

Keywords: MRSA; Endocarditis; Cardiac surgery

An 80-year-old lady presented with a history of pyrexia and rigors two months following a ventricular aneurysmectomy with patch repair. Blood cultures demonstrated methicillin-resistant Staphylococcus aureus (EMRSA15). A transthoracic echocardiography performed on admission showed a large vegetation on the inferior wall of the aneurysm patch (Fig. 1). She was initially treated with intravenous vancomycin (1g BD) according to the sensitivity of the organism. Five days later, the vegetation had become more heterogeneous with an abscess cavity behind the vegetation (Fig. 2). Rethoracotomy was considered to be of too high a risk. Following clinical deterioration her medication was changed to intravenous teicoplanin (400mg od) and rifampicin (300mg qds), and a total of eight weeks intravenous therapy was followed by nine months of oral monotherapy with rifampicin (300mg od). At 1 month there was an infero-basal septal abscess with no identifiable vegetation (Fig. 3). At 9 months there was no evidence of endocarditis, and a small infero-basal septal aneurysm persisted (Fig. 4), with no identifiable left to right shunt. Learning point: recent studies suggest that MRSA endocarditis is becoming more prevalent and is associated with a persistent bacteremia.1 This case highlights the value of long-term oral antibiotic therapy.


Figure 1
View larger version (96K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 1 Vegetation on inferior wall of aneurysm patch.

 


Figure 2
View larger version (81K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 2 Abscess cavity behind vegetation.

 


Figure 3
View larger version (77K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 3 Infero-basal septal abscess with no vegetation.

 


Figure 4
View larger version (70K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 4 Small infero-basal septal aneurysm.

 

   Reference
Top
 Reference
 
  1. Jung Yoon Hee, Yong Choi Jun, Oh Kim Chang, Myung Kim June, Goo Song Young. A comparison of clinical features and mortality among methicillin-resistant and methicillin-sensitive strains of staphylococcus aureus endocarditis. Yonsei Medical Journal (2005) 46(4):496–502.[Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Wiper, A. J.
Right arrow Articles by Roberts, D. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wiper, A. J.
Right arrow Articles by Roberts, D. H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?