A patient with prosthetic aortic valve endocarditis is found to have Staphylococcus lugdunensis growing on blood cultures within 2 months of valve replacement (early prosthetic valve endocarditis). He is hemodynamically stable. The most appropriate management is:

• A Medical therapy alone with oxacillin + rifampicin + gentamicin for 6 weeks
• B Vancomycin alone for 4 weeks
• C Early surgical valve replacement plus appropriate antimicrobial therapy ✓
• D Daptomycin alone; surgical management only if vegetation >2 cm

Explanation

Early prosthetic valve endocarditis (within 12 months of surgery) caused by Staphylococcus, especially with valve dehiscence, abscess, or persistent bacteremia, carries a high mortality with medical therapy alone. Current AHA/ESC guidelines recommend early surgical intervention (Class I) for prosthetic valve endocarditis complicated by valve dysfunction, abscess, new conduction disturbances, or failure to clear bacteremia. S. lugdunensis (coagulase-negative staphylococcus) is more virulent than other CoNS and behaves like S. aureus in prosthetic valve infections. Medical therapy alone has unacceptably high failure rates.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.