Comparison of Dual β-Lactam therapy to penicillin-aminoglycoside combination in treatment of Enterococcus faecalis infective endocarditis

Abdelghani El Rafei, Daniel C. DeSimone, Aalap D. Narichania, M. Rizwan Sohail, Holenarasipur R. Vikram, Zhuo Li, James M. Steckelberg, Walter R. Wilson, Larry M. Baddour

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE. Methods: This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates. Results: Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79%) of patients received A+G while 18 (21%) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17% vs. 17%, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [−0.3, 0.1] mg/dL, P≤.001). Conclusion: A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.

Original languageEnglish (US)
JournalJournal of Infection
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Lactams
Enterococcus faecalis
Aminoglycosides
Endocarditis
Penicillins
gentamicin A
Ampicillin
Therapeutics
Mortality
Creatinine
Recurrence
Ceftriaxone
Serum
Comorbidity
Cohort Studies
Retrospective Studies
Kidney

Keywords

  • Aminoglycoside
  • Ceftriaxone
  • Enterococcus faecalis
  • Infective endocarditis
  • β-lactam

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Comparison of Dual β-Lactam therapy to penicillin-aminoglycoside combination in treatment of Enterococcus faecalis infective endocarditis. / El Rafei, Abdelghani; DeSimone, Daniel C.; Narichania, Aalap D.; Sohail, M. Rizwan; Vikram, Holenarasipur R.; Li, Zhuo; Steckelberg, James M.; Wilson, Walter R.; Baddour, Larry M.

In: Journal of Infection, 01.01.2018.

Research output: Contribution to journalArticle

El Rafei, Abdelghani ; DeSimone, Daniel C. ; Narichania, Aalap D. ; Sohail, M. Rizwan ; Vikram, Holenarasipur R. ; Li, Zhuo ; Steckelberg, James M. ; Wilson, Walter R. ; Baddour, Larry M. / Comparison of Dual β-Lactam therapy to penicillin-aminoglycoside combination in treatment of Enterococcus faecalis infective endocarditis. In: Journal of Infection. 2018.
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abstract = "Background: Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE. Methods: This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates. Results: Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79{\%}) of patients received A+G while 18 (21{\%}) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17{\%} vs. 17{\%}, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [−0.3, 0.1] mg/dL, P≤.001). Conclusion: A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.",
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T1 - Comparison of Dual β-Lactam therapy to penicillin-aminoglycoside combination in treatment of Enterococcus faecalis infective endocarditis

AU - El Rafei, Abdelghani

AU - DeSimone, Daniel C.

AU - Narichania, Aalap D.

AU - Sohail, M. Rizwan

AU - Vikram, Holenarasipur R.

AU - Li, Zhuo

AU - Steckelberg, James M.

AU - Wilson, Walter R.

AU - Baddour, Larry M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE. Methods: This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates. Results: Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79%) of patients received A+G while 18 (21%) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17% vs. 17%, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [−0.3, 0.1] mg/dL, P≤.001). Conclusion: A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.

AB - Background: Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE. Methods: This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates. Results: Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79%) of patients received A+G while 18 (21%) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17% vs. 17%, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [−0.3, 0.1] mg/dL, P≤.001). Conclusion: A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.

KW - Aminoglycoside

KW - Ceftriaxone

KW - Enterococcus faecalis

KW - Infective endocarditis

KW - β-lactam

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