Adjunctive Rifampin for the Treatment of Prosthetic Valve Endocarditis Due to S. Aureus

Inclusion criteria

• Probable or definite prosthetic valve endocarditis involving the tricuspid, pulmonic, mitral and/or aortic valves by the 2023 Duke-ISCVID Criteria (including Cardiac PET evidence if applicable);
• Patient or healthcare proxy provide informed consent.

Exclusion criteria

• Death deemed imminent and inevitable within days or patient will be receiving palliative care and has prognosis < 90 days according to the treating team;
• Patient requires intensive care but has a do not resuscitate order precluding transfer;
• Polymicrobial bacteremia (not including skin commensals or other recognized contaminant);
• Organism tests as rifampin resistant;
• History of hypersensitivity/anaphylaxis or severe adverse reaction to rifampin;
• Category X or other important drug-drug interaction with rifampin which cannot be safely mitigated [with as-needed consultation from experts from pharmacy and/or internal medicine/geriatrics for potential deprescribing];
• Child Pugh Class C cirrhosis;
• Clinician deems rifampin to be mandatory;
• Patient has already received >3 days of rifampin at time of screening or >10 days of total therapy
• Pregnancy or breast feeding

Administrative exclusions:

• No reliable means of outpatient contact (telephone/email/text);
• Previously enrolled;
• Prior S. aureus bacteremia within the preceding 180 days