Experience with Telavancin for Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Endocarditis

Complicated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is becoming increasingly challenging to manage. We have noted that many patients have a poor response to vancomycin and daptomycin, which are the first-line agents recommended by the Infectious Diseases Society of America (IDSA) guidelines for the treatment of MRSA bacteremia. Telavancin has been approved for complicated skin and skin-structure infections and hospital-acquired and ventilator-associated bacterial pneumonia including those with concomitant bacteremia. We analyzed 8 patients with MRSA bacteremia with or without infective endocarditis who were treated with telavancin. Seven out of 8 patients treated for refractory bacteremia had blood cultures cleared on telavancin therapy. One patient died after receiving telavancin for 2 days, soon after cardiac surgery. Five of 8 (62.5%) patients had definite infective endocarditis (IE), 2 had possible IE by modified Duke's Criteria. No patient developed renal failure necessitating a change in antibiotic therapy. While more randomized controlled clinical trials need to be conducted, telavancin may be useful in the management of MRSA endocarditis, and may be especially helpful for patients who have failed first-line therap