[Postoperative mediastinitis due to methicillin resistant Staphylococcus epidermidis with low sensitivity to vancomycin].

Abstract

BACKGROUND:

Vancomycin is the drug of choice for methicillin-resistant Staphylococcus. Antibiotherapy failure is rarely clinically related to Staphylococcus with vancomycin low susceptibility.

CASE REPORT:

A surgical cure of an aortic stenosis in a neonate was complicated by a Staphylococcus mediastinitis. After initiation of antibiotherapy with vancomycin and rifampin and surgical debridement, there was a rapid improvement. Few days later, failure of therapy was obvious. Despite continuous infusion of vancomycin, with a serum level of 29 mg/L, blood cultures were positive again to Staphylococcus. There was no endocarditis or inadequate surgical drainage. Susceptibility of the Staphylococcus was tested, looking for a tolerant strain. The vancomycin minimum bactericidal concentration was 30 mg/L (above usual value 2 to 8 mg/L), while the minimum inhibitory concentration was 3.75 mg/L. A higher dosage of vancomycin associated with fusidic acid was rapidly efficient, and total recovery was achieved.

CONCLUSION:

In case of failure of vancomycin therapy, despite correct serum levels, the susceptibility of the Staphylococcus strain has to be determined. A low susceptibility strain prescribes more prolonged combination of two antibiotics.

• Authors: S Hulin, Y Durandy
• Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie (Arch Pediatr) Vol. 4 Issue 12 Pg. 1204-6 (Dec 1997) ISSN: 0929-693X [Print] France
• Vernacular Title: Médiastinite postopératoire à Staphylococcus epidermidis méthicilline-résistant, à sensibilité réduite à la vancomycine.
• PMID: 9538424 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Fusidic Acid
• Vancomycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Drug Therapy, Combination (therapeutic use)
• Fusidic Acid (therapeutic use)
• Humans
• Infant, Newborn
• Male
• Mediastinitis (etiology, microbiology)
• Methicillin Resistance
• Microbial Sensitivity Tests
• Postoperative Complications (drug therapy)
• Staphylococcal Infections (complications, drug therapy, microbiology)
• Staphylococcus epidermidis
• Surgical Wound Infection (drug therapy)
• Vancomycin (therapeutic use)