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Key Features

  • An important cause of infections of intravascular and prosthetic devices and of wound infection after cardiothoracic surgery

  • Less virulent than Staphylococcus aureus, and infections tend to be more indolent

  • Normal flora of human skin

Clinical Findings

  • Often associated with a foreign body

  • Evidence of prosthetic valve infection

    • Fever

    • New murmur

    • Instability of the prosthesis

    • Signs of embolization

Diagnosis

  • Infection (vs isolation as a contaminant) is more likely if

    • Patient has a foreign body or an intravascular device in place

    • Same strain is isolated from two or more blood cultures and from the foreign body site

  • Contamination: more likely when a single blood culture is positive or if > 1 strain is isolated from blood cultures

    • Antimicrobial susceptibility and speciation can help determine whether multiple strains have been isolated

Treatment

  • Remove the foreign body or intravascular device when possible

    • Sometimes treatment with antibiotics is preferable

    • Surgical management may become necessary

  • Vancomycin, 1 g every 12 hours intravenously, is the treatment of choice unless the strain has an oxacillin MIC ≤ 0.25 mcg/mL, in which case a β-lactam may be used

  • Duration of therapy is not established for infections caused by foreign devices, which may be eliminated by simply removing the device

  • Treat bone or a prosthetic valve infection for 6 weeks

  • Vancomycin plus rifampin, 300 mg twice daily orally, and gentamicin, 1 mg/kg every 8 hours intravenously, is recommended for prosthetic valve endocarditis caused by methicillin-resistant strains

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