ペニシリン低感受性の<i>Streptococcus salivarius </i>による感染性心内膜炎

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  • A Case of Infective Endocarditis Caused by <i>Streptococcus salivarius </i>with Low Penicillin Susceptibility
  • 症例 ペニシリン低感受性のStreptococcus salivariusによる感染性心内膜炎
  • ショウレイ ペニシリン テイカンジュセイ ノ Streptococcus salivarius ニ ヨル カンセンセイシン ナイマクエン

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<p>We successfully treated a patient on maintenance hemodialysis who was diagnosed as having prosthetic valve endocarditis (PVE) caused by Streptococcus salivarius (S. salivarius) with low penicillin susceptibility, using the combination of ceftriaxone with gentamicin at a synergy dose. The patient, a 73-year-old man with end-stage renal disease on maintenance hemodialysis, was referred to our department after 3 days of treatment with oral amoxicillin for fever and chills. Two initial blood cultures were positive for S. salivarius. Transesophageal echocardiography (TEE) performed at admission to our hospital revealed a 0.6-cm vegetation attached to the aortic prosthetic valve. The patient was diagnosed as having PVE caused by S. salivarius, and initiated on treatment with intravenous ampicillin at the dose of 2g every 12 hours with concurrent intravenous gentamycin administration at the dose of 50mg after the commencement of each hemodialysis session. Sensitivity testing revealed intermediate resistance of the causative organism to penicillin and ampicillin. Therefore, the therapy was switched to intravenous ceftriaxone 2g every 24 hours for 6 weeks, with concurrent gentamicin administration at 50mg after the commencement of hemodialysis session. However, gentamicin needed to be discontinued after 18 days because of hearing loss. A repeat TEE at discharge of the patient confirmed disappearance of the vegetation on the prosthetic valve. We conclude that decisions regarding therapeutic and prophylactic interventions for infective endocarditis caused by S. salivarius should be made taking into account the possibility of penicillin resistance of the causative organism.</p>

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  • 感染症学雑誌

    感染症学雑誌 94 (5), 667-671, 2020-09-20

    一般社団法人 日本感染症学会

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