Skip to main content
NCBI home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1978 Mar 4;118(5):524–530.

Combination antibiotic therapy in an outbreak of prosthetic endocarditis caused by Staphylococcus epidermidis.

G W Hammond, H G Stiver
PMCID: PMC1817995  PMID: 343904

Abstract

The efficacy of combination antibiotics in vivo and in vitro was studied during an outbreak of prosthetic endocarditis caused by Staphylococcus epidermidis in 10 patients. The epidemic curve suggested that patients were infected at the time of their operation, with an interval from that time until diagnosis of 11 days to 20 months. The overall mortality was 50%. Four of six patients treated with gentamicin in combination with a penicillin analogue, a cephalosporin or clindamycin survived without reoperation. One of four patients survived when treated with regimens that did not include gentamicin. In vitro studies showed a median minimum inhibitory concentration for methicillin of 8.0 microgram/mL, compared with 0.1 microgram/mL for cephalothin, clindamycin and gentamicin, and a synergistic bactericidal effect between gentamicin and methicillin, cephalothin or clindamycin. These data suggest that gentamicin is a valuable component of combination antibiotic therapy in prosthetic endocarditis caused by S. epidermidis.

Full text

PDF
524

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andriole V. T., Lyons R. W. Coagulase-negative staphylococcus. Ann N Y Acad Sci. 1970 Oct 30;174(2):533–544. doi: 10.1111/j.1749-6632.1970.tb45579.x. [DOI] [PubMed] [Google Scholar]
  2. Appel G. B., Neu H. C. The nephrotoxicity of antimicrobial agents (first of three parts). N Engl J Med. 1977 Mar 24;296(12):663–670. doi: 10.1056/NEJM197703242961205. [DOI] [PubMed] [Google Scholar]
  3. BAIRD-PARKER A. C. A classification of micrococci and staphylococci based on physiological and biochemical tests. J Gen Microbiol. 1963 Mar;30:409–427. doi: 10.1099/00221287-30-3-409. [DOI] [PubMed] [Google Scholar]
  4. Blakemore W. S., McGarrity G. J., Thurer R. J., Wallace H. W., MacVaugh H., 3rd, Coriell L. L. Infection by air-borne bacteria with cardiopulmonary bypass. Surgery. 1971 Dec;70(6):830–838. [PubMed] [Google Scholar]
  5. Block P. C., DeSanctis R. W., Weinberg A. N., Austen W. G. Prosthetic valve endocarditis. J Thorac Cardiovasc Surg. 1970 Oct;60(4):540–548. [PubMed] [Google Scholar]
  6. Conte J. E., Jr, Cohen S. N., Roe B. B., Elashoff R. M. Antibiotic prophylaxis and cardiac surgery. A prospective double-blind comparison of single-dose versus multiple-dose regimens. Ann Intern Med. 1972 Jun;76(6):943–949. doi: 10.7326/0003-4819-76-6-943. [DOI] [PubMed] [Google Scholar]
  7. Dismukes W. E., Karchmer A. W., Buckley M. J., Austen W. G., Swartz M. N. Prosthetic valve endocarditis. Analysis of 38 cases. Circulation. 1973 Aug;48(2):365–377. doi: 10.1161/01.cir.48.2.365. [DOI] [PubMed] [Google Scholar]
  8. Fekety F. R., Jr, Cluff L. E., Sabiston D. C., Jr, Seidl L. G., Smith J. W., Thoburn R. A study of antibiotic prophylaxis in cardiac surgery. J Thorac Cardiovasc Surg. 1969 Jun;57(6):757–763. [PubMed] [Google Scholar]
  9. Geraci J. E., Hanson K. C., Giuliani E. R. Endocarditis caused by coagulase-negative staphylococci. Mayo Clin Proc. 1968 Jun;43(6):420–434. [PubMed] [Google Scholar]
  10. Goodman J. S., Schaffner W., Collins H. A., Battersby E. J., Koenig M. G. Infection after cardiovascular surgery. Clinical study including examination of antimicrobial prophylaxis. N Engl J Med. 1968 Jan 18;278(3):117–123. doi: 10.1056/NEJM196801182780301. [DOI] [PubMed] [Google Scholar]
  11. Keys T. F., Hewitt W. L. Endocarditis due to Micrococci and Staphylococcus epidermidis. Arch Intern Med. 1973 Aug;132(2):216–220. [PubMed] [Google Scholar]
  12. Kluge R. M., Calia F. M., McLaughlin J. S., Hornick R. B. Sources of contamination in open heart surgery. JAMA. 1974 Dec 4;230(10):1415–1418. [PubMed] [Google Scholar]
  13. Mayhall C. G., Medoff G., Marr J. J. Variation in the susceptibility of strains of Staphylococcus aureus to oxacillin, cephalothin, and gentamicin. Antimicrob Agents Chemother. 1976 Oct;10(4):707–712. doi: 10.1128/aac.10.4.707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Murray H. W., Wigley F. M., Mann J. J., Arthur R. R. Combination antibiotic therapy in staphylococcal endocarditis. The use of methicillin sodium-gentamicin sulfate therapy. Arch Intern Med. 1976 Apr;136(4):480–483. [PubMed] [Google Scholar]
  15. Okies J. E., Viroslav J., Williams T. W., Jr Endocarditis after cardiac valvular replacement. Chest. 1971 Feb;59(2):198–202. doi: 10.1378/chest.59.2.198. [DOI] [PubMed] [Google Scholar]
  16. Quenzer R. W., Edwards L. D., Levin S. A comparative study of 48 host valve and 24 prosthetic valve endocarditis cases. Am Heart J. 1976 Jul;92(1):15–22. doi: 10.1016/s0002-8703(76)80399-7. [DOI] [PubMed] [Google Scholar]
  17. Regamey C., Libke R. D., Engelking E. R., Clarke J. T., Kirby M. M. Inactivation of cefazolin, cephaloridine, and cephalothin by methicillin-sensitive and methicillin-resistant strains of Staphylococcus aureus. J Infect Dis. 1975 Mar;131(3):291–294. doi: 10.1093/infdis/131.3.291. [DOI] [PubMed] [Google Scholar]
  18. Sabath L. D. Synergy of antibacterial substances by apparently known mechanisms. Antimicrob Agents Chemother (Bethesda) 1967;7:210–217. [PubMed] [Google Scholar]
  19. Sande M. A., Courtney K. B. Nafcillin-gentamicin synergism in experimental staphylococcal endocarditis. J Lab Clin Med. 1976 Jul;88(1):118–124. [PubMed] [Google Scholar]
  20. Sande M. A., Johnson M. L. Antimicrobial therapy of experimental endocarditis caused by Staphylococcus aureus. J Infect Dis. 1975 Apr;131(4):367–375. doi: 10.1093/infdis/131.4.367. [DOI] [PubMed] [Google Scholar]
  21. Shafer R. B., Hall W. H. Bacterial endocarditis following open heart surgery. Am J Cardiol. 1970 May;25(5):602–607. doi: 10.1016/0002-9149(70)90599-0. [DOI] [PubMed] [Google Scholar]
  22. Slaughter L., Morris J. E., Starr A. Prosthetic valvular endocarditis. A 12-year review. Circulation. 1973 Jun;47(6):1319–1326. doi: 10.1161/01.cir.47.6.1319. [DOI] [PubMed] [Google Scholar]
  23. Steigbigel R. T., Greenman R. L., Remington J. S. Antibiotic combinations in the treatment of experimental Staphylococcus aureus infection. J Infect Dis. 1975 Mar;131(3):245–251. doi: 10.1093/infdis/131.3.245. [DOI] [PubMed] [Google Scholar]
  24. Wilson W. R., Jaumin P. M., Danielson G. K., Giuliani E. R., Washington JA I. I., Geraci J. E. Prosthetic valve endocarditis. Ann Intern Med. 1975 Jun;82(6):751–756. doi: 10.7326/0003-4819-82-6-751. [DOI] [PubMed] [Google Scholar]
  25. Yeh T. J., Anabtawi I. N., Cornett V. E., White A., Stern W. H., Ellison R. G. Bacterial endocarditis following open-heart surgery. Ann Thorac Surg. 1967 Jan;3(1):29–36. doi: 10.1016/s0003-4975(10)66684-2. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES