Rifampin and Gentamicin for Staphylococcal Prosthetic Valve Endocarditis: Strictly Necessary?

Staphylococcal prosthetic valve endocarditis (PVE) is associated with high morbidity and mortality. Guidelines of the American Heart Association and the European Society of Cardiology recommend treatment with rifampin, gentamicin, or both in addition to oxacillin or cefazolin (for methicillin-susceptible Staphylococcus aureus [MSSA]) or vancomycin (for methicillin-resistant S. aureus [MRSA]). However, supporting evidence is scarce and benefits have been questioned. Researchers in Iowa conducted a retrospective multicenter cohort study involving 373 patients admitted with staphylococcal PVE (S. aureus, 61%; coagulase-negative Staphylococcus, 39%) between 2003 and 2021.

Rates of susceptibility to oxacillin, rifampin, and gentamicin were 49%, 9…