Four weeks versus six weeks of ampicillin plus ceftriaxone in Enterococcus faecalis native valve endocarditis: A prospective cohort study

Enterococcus faecalisinfective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to...

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Detalles Bibliográficos
Autores: Ramos-Martinez, Antonio, Pericas, Juan Manuel, Fernández-Cruz, Ana, Munoz, Patricia, Valerio, Maricela, Kestler, Martha, Montejo, Miguel, Farinas Alvarez, Carmen, Sousa, Dolores, Dominguez, Fernando, Ojeda-Burgos, Guillermo, Plata, Antonio, Vidal Bonet, Laura, Miro, Jose Maria, Grp Apoyo Manejo Endocarditis
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/11559
Acceso en línea:https://hdl.handle.net/20.500.13003/11559
Access Level:acceso abierto
Palabra clave:Aged, 80 and over
Gentamicins
Ampicillin
Ceftriaxone
Endocarditis, Bacterial
Humans
Drug Therapy, Combination
Gram-Positive Bacterial Infections
Endocarditis
Male
Prospective Studies
Cohort Studies
Enterococcus faecalis
Aged
Female
Anti-Bacterial Agents
Time Factors
Gentamicinas
Estudios de Cohortes
Factores de Tiempo
Femenino
Infecciones por Bacterias Grampositivas
Masculino
Endocarditis Bacteriana
Quimioterapia Combinada
Ceftriaxona
Humanos
Estudios Prospectivos
Anciano
Anciano de 80 o más Años
Ampicilina
Antibacterianos
Descripción
Sumario:Enterococcus faecalisinfective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.

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