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Enterococcal prosthetic valve endocarditis — RCPSC IM MCQ

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EasyInfectious DiseasesEnterococcal prosthetic valve endocarditisRCPSC IM

A 71-year-old man with a bioprosthetic aortic valve has fever, weight loss, and new splenomegaly. Three blood culture sets grow Enterococcus faecalis susceptible to ampicillin and ceftriaxone. Transesophageal echocardiography shows a 9 mm vegetation without abscess. Creatinine clearance is 38 mL/min. What is the most appropriate management?

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Correct answer: D — Ampicillin plus ceftriaxone for enterococcal prosthetic valve endocarditis

Enterococcal prosthetic valve endocarditis requires prolonged synergistic bactericidal therapy. Ampicillin plus ceftriaxone is appropriate, particularly when aminoglycoside nephrotoxicity is a concern.

Reference: AMMI Canada clinical guidance; endocarditis consensus guidance