Changes in the treatment of Enterococcus faecalis infective endocarditis in Spain in the last 15 years: from ampicillin plus gentamicin to ampicillin plus ceftriaxone. (11th August 2014)

• Record Type: Journal Article
• Authors: Pericas, J. M.; Cervera, C.; del Rio, A.; Moreno, A.; Garcia de la Maria, C.; Almela, M.; Falces, C.; Ninot, S.; Castañeda, X.; Armero, Y.; Soy, D.; Gatell, J. M.; Marco, F.; Mestres, C. A.; Miro, J. M.; The Hospital Clinic Endocarditis Study Group; Mainardi, J.‐L.
• Is Part Of: Clinical microbiology and infection. Volume 20:Number 12(2014:Dec.)
• Page Start: O1075
• Page End: O1083
• Publication Date: 2014-08-11
• Subjects: Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1111/1469-0691.12756
• Languages: English
• ISSNs: 1198-743X

Abstract

<abstract abstract-type="main" id="clm12756-abs-0001"> <title>Abstract</title> <p>The aim of this study was to assess changes in antibiotic resistance, epidemiology and outcome among patients with <italic>Enterococcus faecalis</italic> infective endocarditis (EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our centre from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/day) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4–6 weeks. Increased rates of high‐level aminoglycoside resistance (HLAR; gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997–2006 and 49% in 2007–2011; p<italic> </italic>0.03). The use of A+C increased over time: 1997–2001, 4/18 (22%); 2002–2006, 5/16 (31%); 2007–2011, 30/35 (86%) (p<italic> </italic><0.001). Renal failure developed in 65% of the A+G group and in 34% of the A+C group (p<italic> </italic>0.014). Thirteen patients (43%) in the A+G group had to discontinue treatment, whereas only one patient (3%) treated with A+C had to discontinue treatment (p<italic> </italic><0.001). Only development of heart failure and previous chronic renal failure were independently associated with 1‐year mortality, while the individual antibiotic regimen (A+C vs. A+G) did not affect outcome (OR, 0.7; 95% CI, 0.2–2.2; p 0.549). Our study shows that the prevalence of HLAR EFIE has increased significantly in recent years and that alternative treatment with A+C is safer than A+G, with similar clinical outcomes, although the sample size is too small to draw firm conclusions. Randomized controlled studies are needed to confirm these results.</p> </abstract>