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Staphylococcus epidermidis endocarditis complicating a Starr-Edwards prosthesis. A therapeutic dilemma.

Endocarditis involving a prosthetic valve is a "disease of medical progress."1It is a distinct entity and is becoming an important clinical problem as more and more cardiac valvular replacements are performed. For example, Yeh et al2found that of 126 patients who undervent valvular replacements with Starr-Edwards prostheses, 9.5% developed endocarditis. It presents a therapeutic dilemma to the clinician, since the duration of antibiotic therapy has not been firmly established and the indications for removal of the presumably infected prosthesis are not always clear. In the face of bacterial colonization of intracardiac foreign material, treatment is extremely difficult regardless of the antibiotic susceptibility of the infecting organism. Occasional cases of apparently successful treatment with antibiotic alone3on the one hand, and cases of failure of antibiotic therapy necessitating surgical removal of the infected prostheses on the other, have been recorded.3-5The overall mortality is said