TY - JOUR
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.
N1 - Funding Information:
The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), and two Mayo Named Professorships - the Edward C. Rosenow III, M.D. Professorship in the Art of Medicine (W.R.W.), and the HH Sheikh Khalifa Bin Zayed Al-Nahyan Professorship in Infectious Diseases Honoring Walter R. Wilson, M.D. (L.M.B.), which were paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years.
Publisher Copyright:
© 2018 The British Infection Association
PY - 2018/11
Y1 - 2018/11
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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U2 - 10.1016/j.jinf.2018.06.013
DO - 10.1016/j.jinf.2018.06.013
M3 - Article
AN - SCOPUS:85050112708
VL - 77
SP - 398
EP - 404
JO - Journal of Infection
JF - Journal of Infection
SN - 0163-4453
IS - 5
ER -