Amiyangoda C G K, Wimalaratna H, Bowatte S
Teaching Hospital, Kandy, Sri Lanka.
BMC Res Notes. 2017 Nov 9;10(1):580. doi: 10.1186/s13104-017-2907-z.
Prosthetic valve endocarditis (PVE) due to methicillin resistant Staphylococcus aureus (MRSA) is a rare disease with significant mortality and morbidity. With the emerging resistance and adverse effect profile of vancomycin which is the standard treatment, there is a compelling necessity of an effective alternative for vancomycin. Linezolid is proved as such an agent for infections caused by MRSA in other sites. However to-date the evidence for successful use of linezolid for MRSA prosthetic valve endocarditis is limited only for few case studies. We here present the third case reported as effective treatment of PVE by MRSA with linezolid and probably the first case reported with successful treatment with linezolid in a patient with multiple complications who is a candidate for surgery in standard guidelines.
A 45 years old male from Kandy Sri Lanka, who had undergone prosthetic valve replacement 10 years back, presented with prosthetic mitral valve endocarditis caused by MRSA. He failed to respond to vancomycin and cotrimoxazole while sustaining cerebral haemorrhages, as well as life threatening ventricular arrhythmias. Treatment with intravenous linezolid and ciprofloxacin resulted in a complete response with disappearance of the vegetations and sterilization of blood cultures.
Linezolid can be considered as a good option for treating PVE by MRSA infections who are not responding to vancomycin and may negate the need for a surgery in patients awaiting an early surgery. Further studies including randomized controlled trials are needed to assess the efficacy of linezolid in PVE due to MRSA.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的人工瓣膜心内膜炎（PVE）是一种罕见疾病，具有显著的死亡率和发病率。作为标准治疗药物的万古霉素出现了耐药性和不良反应，因此迫切需要一种有效的替代药物。利奈唑胺已被证明可用于治疗其他部位由MRSA引起的感染。然而，迄今为止，利奈唑胺成功用于治疗MRSA人工瓣膜心内膜炎的证据仅来自少数病例研究。我们在此报告第三例使用利奈唑胺有效治疗MRSA所致PVE的病例，可能也是首例成功使用利奈唑胺治疗的伴有多种并发症且符合标准指南手术指征的患者。
一名来自斯里兰卡康提的45岁男性，10年前接受了人工瓣膜置换术，现因MRSA引起人工二尖瓣心内膜炎就诊。他对万古霉素和复方新诺明治疗无效，同时出现脑出血以及危及生命的室性心律失常。静脉注射利奈唑胺和环丙沙星治疗后病情完全缓解，赘生物消失，血培养转阴。
对于对万古霉素治疗无效的MRSA感染所致PVE患者，利奈唑胺可被视为一种良好的治疗选择，可能使等待早期手术的患者无需接受手术。需要进一步开展包括随机对照试验在内的研究，以评估利奈唑胺在MRSA所致PVE中的疗效。
