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

PLoS One. 2018 Feb 20;13(2):e0192387. doi: 10.1371/journal.pone.0192387. eCollection 2018.

Abstract

Background: 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).

Methods: Retrospective analysis from a prospectively collected cohort of 78 EFIE patients treated with either A+G or A+C.

Results: 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.

Conclusions: A 4-week course of antibiotic treatment might not be suitable neither for A+G nor A+C for treating uncomplicated native valve EFIE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ampicillin / administration & dosage
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Ceftriaxone / administration & dosage
  • Cohort Studies
  • Drug Therapy, Combination
  • Endocarditis, Bacterial / drug therapy*
  • Endocarditis, Bacterial / microbiology
  • Enterococcus faecalis / pathogenicity*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Ceftriaxone
  • Ampicillin

Grants and funding

This study was supported in part by a grant from the “Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III” (Madrid, Spain), the Spanish Network for Research in Infectious Diseases (REIPI RD06/0008), and the “Fundación Máximo Soriano Jiménez” (Barcelona, Spain). During the drafting of the manuscript, JMP received an “Emili Letang” Post-residency Scholarship (2013-14) from Hospital Clinic, Barcelona (Spain) and a “Rio Hortega” Research Grant (CM14/00135; 2015-16) from the ‘Instituto de Salud Carlos III’ and the ‘Ministerio de Economia and Competitividad’, Madrid (Spain). During 2016, JMM received a personal research intensification grant (#INT15/00168) from Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid (Spain) and a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain during 2017-19. None of the sponsors/funders had a significant role in the design and conduct of the study or in data collection, management, analysis, and interpretation. Similarly, they were not involved in the drafting, review, or approval of the manuscript.