1887

Abstract

Introduction:

is an uncommon cause of infective endocarditis (IE) and, despite the fact that synergy between beta‐lactam antibiotics and aminoglycosides has not been demonstrated for lactococci, combination therapy is often used.

Case presentation:

We report a case of suspected IE in an 82‐year‐old man, which was successfully treated with a combination of ampicillin and gentamicin. Despite careful dosing and monitoring of gentamicin levels, the patient developed a transient decrease in renal function and permanent bilateral vestibular deficiency. The combination of gentamicin and ampicillin did not demonstrate synergistic killing effects against the isolate from this patient. However, synergy was noted against two of the four isolates tested. Unfortunately, an Etest‐based method, which would be easy to use in a routine laboratory, was unable to predict synergy in the time‐kill methods.

Conclusions:

The use of combination therapy in IE is based solely on synergy between beta‐lactams and aminoglycosides. Here we demonstrate that a combination of ampicillin and gentamicin induces synergistic killing only of some isolates. Since synergy does not seem to be omnipresent, the risks for aminoglycoside toxicity must be carefully weighed against the potential theoretical benefit of combination therapy in IE.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.000018
2015-02-01
2019-08-25
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/2/1/jmmcr000018.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.000018&mimeType=html&fmt=ahah

References

  1. Chan J.F.W. , Woo P.C.Y. , Teng J.L.L. , Lau S.K.P. , Leung S.S.M. , Tam F.C.C. , Yuen K‐Y. . ( 2011; ). Primary infective spondylodiscitis caused by Lactococcus garvieae and a review of human L.garvieae infections. . Infection 39:, 259–264.[CrossRef]
    [Google Scholar]
  2. Farber B.F. , Eliopoulos G.M. , Ward J.I. , Ruoff K. , Moellering R.C. . ( 1983; ). Resistance to penicillin–streptomycin synergy among clinical isolates of viridans streptococci. . Antimicrob Agents Chemother 24:, 871–875.[CrossRef]
    [Google Scholar]
  3. Pankey G.A. , Ashcraft D.S. , Dornelles A. . ( 2013; ). Comparison of 3 Etest(®) methods and time‐kill assay for determination of antimicrobial synergy against carbapenemase‐producing Klebsiella species. . Diagn Microbiol Infect Dis 77:, 220–226.[CrossRef]
    [Google Scholar]
  4. Rasmussen M. , Björk Werner J. , Dolk M. , Christensson B. . ( 2014; ). Lactococcus garvieae endocarditis presenting with subdural haematoma. . BMC Cardiovasc Disord 14:, 13.[CrossRef]
    [Google Scholar]
  5. Rostagno C. , Pecile P. , Stefàno P.L. . ( 2013; ). Early Lactococcus lactis endocarditis after mitral valve repair: a case report and literature review. . Infection 41:, 897–899. [CrossRef]
    [Google Scholar]
  6. Russo G. , Iannetta M. , D'Abramo A. , Mascellino M.T. , Pantosti A. , Erario L. , Tebano G. , Oliva A. , D'Agostino C. . other authors. ( 2012; ). Lactococcus garvieae endocarditis in a patient with colonic diverticulosis: first case report in Italy and review of the literature. . New Microbiol 35:, 495–501.
    [Google Scholar]
  7. Wang C‐Y.C. , Shie H‐S. , Chen S‐C. , Huang J‐P. , Hsieh I‐C. , Wen M‐S. , Lin F‐C. , Wu D. . ( 2007; ). Lactococcus garvieae infections in humans: possible association with aquaculture outbreaks. . Int J Clin Pract 61:, 68–73.[CrossRef]
    [Google Scholar]
  8. Weinstein A.J. , Moellering R.C. . ( 1975; ). Studies of cephalothin : aminoglycoside synergism against enterococci. . Antimicrob Agents Chemother 7:, 522–529.[CrossRef]
    [Google Scholar]
  9. Winstanley T.G. , Hastings J.G. . ( 1990; ). Synergy between penicillin and gentamicin against enterococci. . J Antimicrob Chemother 25:, 551–560.[CrossRef]
    [Google Scholar]
  10. Wood H.F. , Jacobs, K J. , McCarty M. . ( 1955; ). Streptococcus lactis isolated from a patient with subacute bacterial endocarditis. . Am J Med 18:, 345–347.[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.000018
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.000018
Loading

Data & Media loading...

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error