260
￭
Sat-413￭
A Case of Prosthetic Valve Endocarditis with Cerebral Hemorrhage Caused by Rothia mucilaginosa
1한양대학교병원 내과, 2한양대학교병원 감염내과, 3한양대학교병원 진단검사의학과
*
송여진
1, 김봉영
2, 김영은
3, 이양순
3, 배현주
2Introduction: Rothia spp. are aerobic, gram-positive cocci belonging to the family Micrococcaceae, which are part of normal flora of the human orophar- ynx and upper respiratory tract. We present the first case of prosthetic valve endocarditis with cerebral hemorrhage caused by Rothia mucaliginosa in South Korea. Case report: A 65-year-old man presented to an outpatient clinic with persistent fever for a month and newly onset severe headache. The patient underwent aortic valvuloplasty owing to infective endocarditis with aortic stenosis for two times. On transesophageal echocardiography (TEE), a 1.2cm sized linear hypermobile structure was found at left ventricular outflow tract. Taking together these findings with the result of blood culture which were ob- tained at outpatient department 6 days before admission, we suspected prosthetic valve endocarditis; Rothia mucilaginosa was reported from one blood cul- ture bottle among 4 sets of blood culture samples. Besides, multiple microhemorrhages suggesting septic emboli were found on both hemisphere, cortico- medullary junction area and cerebellum at brain magnetic resonance imag-
ing (MRI). We started vancomycin, rifampin, and ceftriaxone as an em- pirical therapy and changed to ampicillin and rifampin after the result of antimicrobial susceptibility test was reported. Because aggravation of in- tracranial hemorrhage was found, we changed antibiotic regimen to van- comycin with rifampin again, and his neurologic symptoms and signs were improved. Conclusion: Rothia spp. should be considered as a possi- ble pathogen in case of infective endocarditis with intracranial hemorrhage.
￭
Sat-414￭
Efficacy of vancomycin trough concentration on the outcome of patients with enterococcal bacteremia
1연세대학교 의과대학 내과학교실, 2연세대학교 의과대학 AIDS research Institute
*
손유진
1, 안상민
1, 이용섭
1, 조윤숙
1, 현종훈
1, 김준형
1,2, 이운지
1,2, 김정호
1,2, 성혜
1,2, 안진영
1,2, 정수진
1,2, 최준용
1,2, 염준섭
1,2, 구남수
1,2Background/Aims: It is widely known that pharmacokinetic-pharmacodynamic targets for vancomycin therapy are recognized for invasive methi- cillin-resistant Staphylococcus aureus infections, but not in other gram-positive infections. The aim of this study was to determine whether vancomycin concentration targets are associated with clinical outcome in enterococcal bacteremia and to determine which of the Trough level and Area Under the Curve / Minimun Inhibitory Cconcentration(AUC/MIC) is the better parameter Methods: A retrospective analysis was conducted among adult patients with van- comycin-susceptible enterococcal bacteremia who were treated with vancomycin from 1 January 2007 to 31 December 2017 in a tertiary hospital, Seoul, South Korea. Patients without results of vancomycin concentration were excluded. The primary outcome was the 28-day all-cause mortality. Results: 37 patients were finally enrolled in this study (26 Enterococcus faecium and 11 Enterococcus faecalis). There were no significant differences in baseline char- acteristics between the two groups. The 28-day mortality rate was 21.6%. Higher vancomycin trough level (>15㎍/mL) was significantly associated with reduced mortality (p value=0.042). But,, the AUC / MIC pharmacodynamic target was not significantly associated with reduced mortality. Conclusions: In this study, vancomycin trough level above 15 ㎍/mL was associated with reduced mortality in enterococcal bacteremia, but not with AUC/MIC values.
Therefore, it is thought that the trough level of vancomycin can be a better predictor of the efficacy of vancomycin in enterococcal bacteremia.
260
￭
Sat-413￭
A Case of Prosthetic Valve Endocarditis with Cerebral Hemorrhage Caused by Rothia mucilaginosa
1한양대학교병원 내과, 2한양대학교병원 감염내과, 3한양대학교병원 진단검사의학과
*
송여진
1, 김봉영
2, 김영은
3, 이양순
3, 배현주
2Introduction: Rothia spp. are aerobic, gram-positive cocci belonging to the family Micrococcaceae, which are part of normal flora of the human orophar- ynx and upper respiratory tract. We present the first case of prosthetic valve endocarditis with cerebral hemorrhage caused by Rothia mucaliginosa in South Korea. Case report: A 65-year-old man presented to an outpatient clinic with persistent fever for a month and newly onset severe headache. The patient underwent aortic valvuloplasty owing to infective endocarditis with aortic stenosis for two times. On transesophageal echocardiography (TEE), a 1.2cm sized linear hypermobile structure was found at left ventricular outflow tract. Taking together these findings with the result of blood culture which were ob- tained at outpatient department 6 days before admission, we suspected prosthetic valve endocarditis; Rothia mucilaginosa was reported from one blood cul- ture bottle among 4 sets of blood culture samples. Besides, multiple microhemorrhages suggesting septic emboli were found on both hemisphere, cortico- medullary junction area and cerebellum at brain magnetic resonance imag-
ing (MRI). We started vancomycin, rifampin, and ceftriaxone as an em- pirical therapy and changed to ampicillin and rifampin after the result of antimicrobial susceptibility test was reported. Because aggravation of in- tracranial hemorrhage was found, we changed antibiotic regimen to van- comycin with rifampin again, and his neurologic symptoms and signs were improved. Conclusion: Rothia spp. should be considered as a possi- ble pathogen in case of infective endocarditis with intracranial hemorrhage.
￭
Sat-414￭
Efficacy of vancomycin trough concentration on the outcome of patients with enterococcal bacteremia
1연세대학교 의과대학 내과학교실, 2연세대학교 의과대학 AIDS research Institute
*
손유진
1, 안상민
1, 이용섭
1, 조윤숙
1, 현종훈
1, 김준형
1,2, 이운지
1,2, 김정호
1,2, 성혜
1,2, 안진영
1,2, 정수진
1,2, 최준용
1,2, 염준섭
1,2, 구남수
1,2 Background/Aims: It is widely known that pharmacokinetic-pharmacodynamic targets for vancomycin therapy are recognized for invasive methi- cillin-resistant Staphylococcus aureus infections, but not in other gram-positive infections. The aim of this study was to determine whether vancomycin concentration targets are associated with clinical outcome in enterococcal bacteremia and to determine which of the Trough level and Area Under the Curve / Minimun Inhibitory Cconcentration(AUC/MIC) is the better parameter Methods: A retrospective analysis was conducted among adult patients with van- comycin-susceptible enterococcal bacteremia who were treated with vancomycin from 1 January 2007 to 31 December 2017 in a tertiary hospital, Seoul, South Korea. Patients without results of vancomycin concentration were excluded. The primary outcome was the 28-day all-cause mortality. Results: 37 patients were finally enrolled in this study (26 Enterococcus faecium and 11 Enterococcus faecalis). There were no significant differences in baseline char- acteristics between the two groups. The 28-day mortality rate was 21.6%. Higher vancomycin trough level (>15㎍/mL) was significantly associated with reduced mortality (p value=0.042). But,, the AUC / MIC pharmacodynamic target was not significantly associated with reduced mortality. Conclusions: In this study, vancomycin trough level above 15 ㎍/mL was associated with reduced mortality in enterococcal bacteremia, but not with AUC/MIC values.Therefore, it is thought that the trough level of vancomycin can be a better predictor of the efficacy of vancomycin in enterococcal bacteremia.
