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Staphylococcal Endocarditis: Some Clinical and Therapeutic Observations on Thirty-Eight Cases

Staphylococcal Endocarditis: Some Clinical and Therapeutic Observations on Thirty-Eight Cases Abstract Infections due to Micrococcus pyogenes (Staphylococcus) are becoming increasingly difficult to manage because of the remarkable tendency of members of this genus to develop resistance to penicillin and other antibiotics. Although the individual strains vary considerably in this respect, the majority of staphylococci isolated from hospital patients and personnel in several clinics are currently being found to be penicillin-resistant.* During the past few years we have followed the course of several patients with staphylococcal endocarditis. Of interest is a comparison of the results of therapy in this group with a much larger series obtained by reviewing the records of all such cases at the Johns Hopkins Hospital for the past 20 years. This series was divided arbitrarily into three periods. The first was 1933-1943, a time in which no well-established antibiotic treatment was available, although penicillin was used in a few of the later cases in doses which we now References 1. References 1-4. 2. Only three cases of staphylococcal endocarditis were encountered in this middle period. One strain was sensitive to penicillin, being killed by 0.02 μ/cc.; the others were not tested. 3. This case was not included in our series. 4. In this and all similar reports the bactericidal level of the serum is recorded as the highest dilution at which there is no growth of the specific Staphylococcus on subculture. The level of inhibition is the highest dilution at which there is evidence of suppression of growth both grossly and on subculture after 24 hours of incubation. 5. References 1-3. 6. References 5-8. 7. References 4, 13, and 16. 8. References 1-4. 9. References 9-13. 10. Finland, M., and Haight, T. H.: Antibiotic Resistance of Pathogenic Staphylococci , A. M. A. Arch. Int. Med. 91:143 ( (Feb.) ) 1953.Crossref 11. Dowling, H. F.; Lepper, M. H., and Jackson, G. G.: Observations on Epidemiological Spread of Antibiotic-Resistant Staphylococci, with Measurement of Changes in Sensitivity to Penicillin and Aureomycin , Am. J. Pub. Health 43:860 ( (July) ) 1953.Crossref 12. Laurell, G., and Wallmark, G.: Studies on Staphylococcus Aureus Pyogenes in a Children's Hospital , Acta path. et microbiol. scandinav. 32: 438, 1953.Crossref 13. Spink, W. W.: Staphylococcal Infections and the Problem of Antibiotic-Resistant Staphylococci , A. M. A. Arch. Int. Med. 94:167 ( (Aug.) ) 1954.Crossref 14. Harvey, J. C.; Mirick, G. S., and Schaub, I. G.: Clinical Experiences with Aureomycin , J. Clin. Invest. 28:987 ( (Sept.) ) 1949.Crossref 15. Hunter, T. H.: Speculations on the Mechanism of Cure of Bacterial Endocarditis , J. A. M. A. 144:524 ( (Oct. 14) ) 1950.Crossref 16. Friedberg, C. K.: Subacute Bacterial Endocarditis: Revision of Diagnostic Criteria and Therapy , J. A. M. A. 144:527 ( (Oct. 14) ) 1950.Crossref 17. Friedberg, C. K.: Treatment of Subacute Bacterial Endocarditis with Aureomycin , J. A. M. A. 148:98 ( (Jan. 12) ) 1952.Crossref 18. Heilman, F. R.; Herrell, W. E.; Wellman, W. E., and Geraci, J. E.: Some Laboratory and Clinical Observations on a New Antibiotic, Erythromycin (Ilotycin) , Proc. Staff Meet., Mayo Clin. 27:285 ( (July 16) ) 1952. 19. Needham, G. M., and Nichols, D. R.: Recent Changes in Sensitivity of Micrococcus Pyogenes to Various Antibiotic Agents , J. Lab. & Clin. Med. 41:150 ( (Jan.) ) 1953. 20. Finland, M., and Wilcox, C.: Antibiotic Combinations and Resistance to Antibiotics: Penicillin and Other Antibiotics Against Penicillin-Resistant Staphylococci , Proc. Soc. Exper. Biol. & Med. 83:605 ( (July) ) 1953. 21. Coleman, V. R.; Gunnison, J. B., and Jawetz, E.: Participation of Erythromycin and Carbomycin in Combined Antibiotic Action in Vitro , Proc. Soc. Exper. Biol. & Med. 83:668 ( (Aug.-Sept.) ) 1953. 22. Geraci, J. E., and Martin, W. J.: Antibiotic Therapy of Bacterial Endocarditis: V. Therapeutic Considerations of Erythromycin , Proc. Staff Meet., Mayo Clin. 29:109 ( (Feb. 24) ) 1954. 23. Thayer, W. S.: Studies on Bacterial (Infective) Endocarditis , Johns Hopkins Hosp. Rep. 22:1, 1926. 24. Dowling, H. F.; Lepper, M. H.; Caldwell, E. R., and Spies, H. W.: Staphylococcic Endocarditis: An Analysis of 25 Cases Treated with Antibiotics, Together with a Review of Recent Literature , Medicine 31:155 ( (May) ) 1952. 25. Rantz, L. A., and Randall, E.: Antibiotic Synergism and Staphylococcus Aureus , Antibiotics & Chemother. 2:645 ( (Dec.) ) 1952. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

Staphylococcal Endocarditis: Some Clinical and Therapeutic Observations on Thirty-Eight Cases

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References (23)

Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1955.00250090065009
Publisher site
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Abstract

Abstract Infections due to Micrococcus pyogenes (Staphylococcus) are becoming increasingly difficult to manage because of the remarkable tendency of members of this genus to develop resistance to penicillin and other antibiotics. Although the individual strains vary considerably in this respect, the majority of staphylococci isolated from hospital patients and personnel in several clinics are currently being found to be penicillin-resistant.* During the past few years we have followed the course of several patients with staphylococcal endocarditis. Of interest is a comparison of the results of therapy in this group with a much larger series obtained by reviewing the records of all such cases at the Johns Hopkins Hospital for the past 20 years. This series was divided arbitrarily into three periods. The first was 1933-1943, a time in which no well-established antibiotic treatment was available, although penicillin was used in a few of the later cases in doses which we now References 1. References 1-4. 2. Only three cases of staphylococcal endocarditis were encountered in this middle period. One strain was sensitive to penicillin, being killed by 0.02 μ/cc.; the others were not tested. 3. This case was not included in our series. 4. In this and all similar reports the bactericidal level of the serum is recorded as the highest dilution at which there is no growth of the specific Staphylococcus on subculture. The level of inhibition is the highest dilution at which there is evidence of suppression of growth both grossly and on subculture after 24 hours of incubation. 5. References 1-3. 6. References 5-8. 7. References 4, 13, and 16. 8. References 1-4. 9. References 9-13. 10. Finland, M., and Haight, T. H.: Antibiotic Resistance of Pathogenic Staphylococci , A. M. A. Arch. Int. Med. 91:143 ( (Feb.) ) 1953.Crossref 11. Dowling, H. F.; Lepper, M. H., and Jackson, G. G.: Observations on Epidemiological Spread of Antibiotic-Resistant Staphylococci, with Measurement of Changes in Sensitivity to Penicillin and Aureomycin , Am. J. Pub. Health 43:860 ( (July) ) 1953.Crossref 12. Laurell, G., and Wallmark, G.: Studies on Staphylococcus Aureus Pyogenes in a Children's Hospital , Acta path. et microbiol. scandinav. 32: 438, 1953.Crossref 13. Spink, W. W.: Staphylococcal Infections and the Problem of Antibiotic-Resistant Staphylococci , A. M. A. Arch. Int. Med. 94:167 ( (Aug.) ) 1954.Crossref 14. Harvey, J. C.; Mirick, G. S., and Schaub, I. G.: Clinical Experiences with Aureomycin , J. Clin. Invest. 28:987 ( (Sept.) ) 1949.Crossref 15. Hunter, T. H.: Speculations on the Mechanism of Cure of Bacterial Endocarditis , J. A. M. A. 144:524 ( (Oct. 14) ) 1950.Crossref 16. Friedberg, C. K.: Subacute Bacterial Endocarditis: Revision of Diagnostic Criteria and Therapy , J. A. M. A. 144:527 ( (Oct. 14) ) 1950.Crossref 17. Friedberg, C. K.: Treatment of Subacute Bacterial Endocarditis with Aureomycin , J. A. M. A. 148:98 ( (Jan. 12) ) 1952.Crossref 18. Heilman, F. R.; Herrell, W. E.; Wellman, W. E., and Geraci, J. E.: Some Laboratory and Clinical Observations on a New Antibiotic, Erythromycin (Ilotycin) , Proc. Staff Meet., Mayo Clin. 27:285 ( (July 16) ) 1952. 19. Needham, G. M., and Nichols, D. R.: Recent Changes in Sensitivity of Micrococcus Pyogenes to Various Antibiotic Agents , J. Lab. & Clin. Med. 41:150 ( (Jan.) ) 1953. 20. Finland, M., and Wilcox, C.: Antibiotic Combinations and Resistance to Antibiotics: Penicillin and Other Antibiotics Against Penicillin-Resistant Staphylococci , Proc. Soc. Exper. Biol. & Med. 83:605 ( (July) ) 1953. 21. Coleman, V. R.; Gunnison, J. B., and Jawetz, E.: Participation of Erythromycin and Carbomycin in Combined Antibiotic Action in Vitro , Proc. Soc. Exper. Biol. & Med. 83:668 ( (Aug.-Sept.) ) 1953. 22. Geraci, J. E., and Martin, W. J.: Antibiotic Therapy of Bacterial Endocarditis: V. Therapeutic Considerations of Erythromycin , Proc. Staff Meet., Mayo Clin. 29:109 ( (Feb. 24) ) 1954. 23. Thayer, W. S.: Studies on Bacterial (Infective) Endocarditis , Johns Hopkins Hosp. Rep. 22:1, 1926. 24. Dowling, H. F.; Lepper, M. H.; Caldwell, E. R., and Spies, H. W.: Staphylococcic Endocarditis: An Analysis of 25 Cases Treated with Antibiotics, Together with a Review of Recent Literature , Medicine 31:155 ( (May) ) 1952. 25. Rantz, L. A., and Randall, E.: Antibiotic Synergism and Staphylococcus Aureus , Antibiotics & Chemother. 2:645 ( (Dec.) ) 1952.

Journal

A.M.A. Archives of Internal Medicine – American Medical Association

Published: Mar 1, 1955

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