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Open Access Highly Accessed Case report

Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

Giuseppe Chesi1, Andrea Colli2*, Carlos A Mestres3, Gianpaolo Gambarati1, Fabrizio Boni1 and Tiziano Gherli2

Author Affiliations

1 Department of Internal Medicine, "C. Magati" Hospital, Via Martiri della libertà 8, 42019 Scandiano (RE), Italy

2 Department of Cardiac Surgery, University of Parma, Via Gramsci 13, 43100 Parma, Italy

3 Department of Cardiovascular Surgery, Hospital Clinic, Villaroel 170, 08036 Barcelona, Spain

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BMC Infectious Diseases 2006, 6:124  doi:10.1186/1471-2334-6-124

Published: 26 July 2006

Abstract

Background

Methicillin-resistant S. aureus (MRSA) with low susceptibility to glycopeptides is uncommon.

Case presentation

The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE) by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin – rifampicin – cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin.

Conclusion

The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin