STUDY DESIGN: Case ReportSETTING: National Kidney and Transplant InstituteInfective encocardits (IE) is a microbial infection of the endothelial surface of the heart usually affecting the left sided valves. Only 5-10 percent of cases of IE affect the right side, the tricuspid valve, and majority occur among injection drug users. Mortality rate is high at 25-47 percent. This is a report of successful medical treatment of an oxacillin-resistant Staphylococcus Aureus (ORSA) infective endocarditis affecting the tricuspid valve.The objectives of this paper is to present a rare case of tricuspid valve infective endocarditis in an Injection drug user and to discuss the approach in the diagnosis and management of ORSA endocarditis.The patient is a 37-year old male, Korean, on chronic intravenous nalbuphine because of pain from a fractured left tibia. He presented with a three-week history of fever, chills, cough and pleuritic chest pain later accompanied by jaundice, tea-colored urine, abdominal pain and respiratory distress. Clinically, the patient was in septic shock, with signs of tricuspid insufficiency i.e., grade 2/6 systolic murmur at the right paresternal area, distended neck veins and jaundice. Echocardiography showed vegetations on the tricuspid valve and blood cultures grew oxacillin-resistant Staphylococcus aureus (ORSA) (MIC: 2 ug/ ml). The patient also had hospital acquired pneumonia. Endotracheal tube aspirate cultures showed growth of Pseudomonas aeruginosa resistant to all antibiotics. He developed acute renal failure requiring regular hemodialysis. He was successfully treated with vancomycin, rifampicin and cotrimoxazole for the infective endocarditis, and meropenem and gentamycin for the hospital-acquired pneumonia. (Author)
Human ; Adult ; Staphylococcus Aureus ; Oxacillin ; Endocarditis, Infective ; Oxacillin Resistant Staphylococcus Aureus