Improved Neurological Outcome in a Patient With Complicated Mitral Valve Endocarditis Treated With Daptomycin-Rifampin Regimen

Complicated infective endocarditis (IE) with symptomatic neurological involvement is associated with a poor prognosis. Vancomycin is the first-line antibiotic employed for the treatment of IE as general resistance of Methicillin-resistant Staphylococcus aureus (MRSA) to vancomycin is low and the antibiotic is well tolerated. In this case report, we describe a case of severely complicated MRSA endocarditis initially treated unsuccessfully with vancomycin. Our patient presented with severe encephalopathy with multiple septic infarctions noted on imaging. After treatment with a daptomycin-rifampin regimen, significant clinical improvement was noted. Based on the findings of this case report, what remains to be analyzed further with future studies is whether the daptomycin-rifampin regimen effect is independent of initial vancomycin-based treatment as most cases of IE are first treated with vancomycin and are only transitioned into daptomycin-rifampin regimen after treatment failure or persistent positive blood cultures, as is described in this case.