Early prosthetic valve endocarditis is commonly caused by coagulase-negative staphylococci which are characteristically resistant to methicillin ( Wolff. etal 1995).
Late endocarditis is usually caused by more susceptible organisms. Teicoplanin is less active than vancomycin against Staphylococcus hemolyticus and some strains of Staphylococcus epidermidis. Vancomycin or teicoplanin plus rifampin and/or gentamicin is suitable. For methicillin-susceptible strains, flucloxacillin, nafcillin, or oxacillin are used instead of the glycopeptide. United States recommendations are that three drugs be used to prevent emergence of resistance to rifampin ( Wilson et.
al 1995). Surgery is usually required for paraprosthetic leak or valvular root abscess before a response to treatment can be expected.
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