Gentamicin/vancomycin

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 38-year-old man exhibited lack of efficacy with gentamicin and vancomycin, while being treated for Enterococcus faecalis infection.

The man, who had fatigue, nonproductive cough, shortness of breath for 2 weeks, presented to the clinic. His medical history included end-stage renal disease secondary to hypertensive nephropathy. He required haemodialysis for the management of end-stage renal disease. He developed fever several hours following the presentation. On admission, various laboratory investigations showed II/VI systolic ejection murmur, borderline first degree AV block, left anterior fascicular block and Coronavirus disease 2019 (COVID-19) infection. Additionally, his blood culture showed growth of Enterococcus faecalis. Therefore, he started receiving treatment with IV antibiotic regimen comprised of vancomycin and gentamicin [dosages not stated] for Enterococcus faecalis infection. However, despite several days of antibiotic therapy, persistent bacteremia was noted (lack of efficacy). His dialysis catheter was exchanged due to suspected infectious source. Thereafter, based on further investigations, severe aortic insufficiency (AI) was diagnosed. Following the consultation with multispecialty team, he underwent aortic valve replacement surgery. He was extubated a few hours following the surgery. His aortic valve culture showed growth of Enterococcus faecalis. Hence, he was diagnosed with aortic valve infective endocarditis (IE). The test for COVID-19 was also repeated, and he remained positive for COVID-19 infection. His antibiotics treatment was switched to ampicillin and ceftriaxone. Thereafter, he was discharged home to complete a 6 week course.