Aminoglycosides For Surgically-Treated Enterococcal Endocarditis

• Published in: Seminars in thoracic and cardiovascular surgery 2016, Vol.28 (2), p.331-338
• Main Authors: Banzon, Jona M., MD, Hussain, Syed T., MD, Gordon, Steven M., MD, Pettersson, Gosta B., MD, PhD, Butler, Robert S., MS, Shrestha, Nabin K., MD, MPH
• Format: Article
• Language: English
• Subjects: Aged; aminoglycosides; Aminoglycosides - adverse effects; Aminoglycosides - therapeutic use; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; antibiotics; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiothoracic Surgery; Chi-Square Distribution; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - microbiology; Endocarditis, Bacterial - mortality; Endocarditis, Bacterial - therapy; Enterococcus - drug effects; Enterococcus - pathogenicity; Female; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - mortality; Gram-Positive Bacterial Infections - therapy; Humans; infection; infective endocarditis; Logistic Models; Male; Middle Aged; Multivariate Analysis; Ohio; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Factors; surgery; Time Factors; Treatment Outcome
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2016.04.018

Objective Aminoglycosides are a mainstay of treatment for enterococcal infective endocarditis. However, the benefit of adding aminoglycosides to cell wall-active agents after surgery is unclear. The aim of this study was to determine if adjunctive aminoglycoside treatment after surgery for enterococcal endocarditis leads to better outcomes. Methods We included patients who underwent surgery for enterococcal endocarditis at our institution between July 2007 and July 2014. Treatment was defined as at least one dose of an aminoglycoside after surgery. Propensity to receive aminoglycosides was calculated in a model that included age, native vs. prosthetic valve endocarditis, chronic kidney disease, high-level aminoglycoside resistance, metastatic infection, invasive disease, positive valve culture, and creatinine on the day of surgery. A multivariable Cox proportional hazards model was used to compare the primary outcome of death, adjusted for propensity to receive aminoglycosides, among patients who did and did not receive aminoglycosides. Results 108 patients were identified. 37 (34%) received at least one dose of an aminoglycoside after surgery, with a median duration of 5 days (IQR 2.5-10). In the multivariable model, patients treated with adjunctive aminoglycoside therapy had better survival than those treated with a cell-wall active agent alone, although the difference did not reach statistical significance (HR 0.65, 95% CI 0.32-1.33). The survival difference was consistently present in subgroups stratified by APR-DRG mortality risk, and with varying definitions of aminoglycoside therapy. Conclusion Antibiotic monotherapy with a cell wall-active agent after surgery for enterococcal endocarditis may be inferior to combination therapy including an aminoglycoside.