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Prosthetic Valve Endocarditis — RACP Adult Medicine MCQ

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HardInfectious DiseasesProsthetic Valve EndocarditisRACP Adult Medicine

A 55-year-old woman with a prosthetic mitral valve presents with fever, night sweats, and a new paravalvular leak on TEE. Blood cultures grow coagulase-negative Staphylococcus (methicillin-resistant). The vegetation is 8 mm. What is the most appropriate antibiotic regimen?

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Correct answer: D — Vancomycin IV for 6 weeks

Methicillin-resistant CoNS prosthetic valve endocarditis requires IV vancomycin for ≥6 weeks. Rifampicin is added once blood cultures are clear (after initial bactericidal therapy), and gentamicin for the first 2 weeks. The paravalvular leak is a relative indication for early surgery. Surgical consultation is mandatory.

Reference: eTG Antibiotic – 2025 – Endocarditis; ESC 2023 IE Guidelines