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Infective Endocarditis — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionInfective EndocarditisSCE Infectious Diseases

A 48-year-old man is admitted with fever, night sweats, and weight loss over 6 weeks. He has a prosthetic aortic valve inserted 3 months ago. Blood cultures (3 sets) grow Staphylococcus epidermidis. TOE confirms a 12 mm vegetation on the prosthetic valve with no abscess. The organism is methicillin-resistant. What is the most appropriate antibiotic regimen?

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Correct answer: B — Vancomycin IV plus Rifampicin oral plus Gentamicin IV for 2 weeks then Vancomycin plus Rifampicin for at least 4 further weeks

Methicillin-resistant coagulase-negative staphylococcal prosthetic valve endocarditis requires triple therapy: Vancomycin IV (targeting trough 15–20 mg/L) plus Rifampicin (300–600 mg BD oral) plus Gentamicin IV for the initial 2 weeks. Rifampicin is crucial for eradicating biofilm on prosthetic material but should only be added after blood cultures have sterilised. Gentamicin is then stopped after 2 weeks, and Vancomycin plus Rifampicin continues for a minimum total of 6 weeks. ESC 2023 endocarditis guidelines support replacing Gentamicin with Rifampicin after blood culture sterilisation.

Reference: ESC 2023 – Guidelines for the management of endocarditis; BSAC 2012 – Guidelines for treatment of endocarditis