Outcome of Enterococcus faecalis infective endocarditis according to the length of antibiotic therapy: Preliminary data from a cohort of 78 patients

International guidelines recommend 4 weeks of treatment with ampicillin plus gentamicin (A+G) for uncomplicated native valve Enterococcus faecalis infective endocarditis (EFIE) and 6 weeks in the remaining cases. Ampicillin plus ceftriaxone (A+C) is always recommended for at least 6w, with no availa...

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Published in:PloS one 2018-02, Vol.13 (2), p.e0192387-e0192387
Main Authors: Pericàs, Juan M, Cervera, Carlos, Moreno, Asunción, Garcia-de-la-Mària, Cristina, Almela, Manel, Falces, Carles, Quintana, Eduard, Vidal, Bàrbara, Llopis, Jaume, Fuster, David, Mestres, Carlos A, Marco, Francesc, Miró, Jose M
Format: Article
Language:English
Subjects:
Ampicillin
Antibiotics
Bacterial infections
Biology and Life Sciences
Cardiology
Care and treatment
Ceftriaxone
Development and progression
Drug therapy
Endocarditis
Enterococcal infections
Enterococcus faecalis
Gentamicin
Heart surgery
Infectious diseases
Laboratories
Medicine and Health Sciences
Methods
Mortality
Patients
Practice guidelines (Medicine)
Prostheses
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Summary:International guidelines recommend 4 weeks of treatment with ampicillin plus gentamicin (A+G) for uncomplicated native valve Enterococcus faecalis infective endocarditis (EFIE) and 6 weeks in the remaining cases. Ampicillin plus ceftriaxone (A+C) is always recommended for at least 6w, with no available studies assessing its suitability for 4w. We aimed to investigate differences in the outcome of EFIE according to the duration (4 versus 6 weeks) of antibiotic treatment (A+G or A+C). Retrospective analysis from a prospectively collected cohort of 78 EFIE patients treated with either A+G or A+C. 32 cases (41%) were treated with A+G (9 for 4w, 28%) and 46 (59%) with A+C (14 for 4w, 30%). No significant differences were found in 1-year mortality according to the type of treatment (31% and 24% in A+G and A+C, respectively; P = 0.646) or duration (26% and 27% at 4 and 6w, respectively; P = 0.863). Relapses were more frequent among survivors treated for 4w than in those treated for 6w (3/18 [17%] at 4w and 1/41 [2%] at 6w; P = 0.045). Three out of 4 (75%) relapses occurred in cirrhotic patients. A 4-week course of antibiotic treatment might not be suitable neither for A+G nor A+C for treating uncomplicated native valve EFIE.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0192387