Ampicillin Plus Ceftriaxone Is as Effective as Ampicillin Plus Gentamicin for Treating Enterococcus faecalis Infective Endocarditis
Por:
Fernandez-Hidalgo, N, Almirante, B, Gavalda, J, Gurgui, M, Pena, C, de Alarcon, A, Ruiz, J, Vilacosta, I, Montejo, M, Vallejo, N, Lopez-Medrano, F, Plata, A, Lopez, J, Hidalgo-Tenorio, C, Galvez, J, Saez, C, Lomas, JM, Falcone, M, de la Torre, J, Martinez-Lacasa, X, Pahissa, A
Publicada:
1 may 2013
Resumen:
Background. The aim of this study was to compare the effectiveness of the ampicillin plus ceftriaxone (AC) and ampicillin plus gentamicin (AG) combinations for treating Enterococcus faecalis infective endocarditis (EFIE).
Methods. An observational, nonrandomized, comparative multicenter cohort study was conducted at 17 Spanish and 1 Italian hospitals. Consecutive adult patients diagnosed of EFIE were included. Outcome measurements were death during treatment and at 3 months of follow-up, adverse events requiring treatment withdrawal, treatment failure requiring a change of antimicrobials, and relapse.
Results. A larger percentage of AC-treated patients (n = 159) had previous chronic renal failure than AG-treated patients (n = 87) (33% vs 16%, P = .004), and AC patients had a higher incidence of cancer (18% vs 7%, P = .015), transplantation (6% vs 0%, P = .040), and healthcare-acquired infection (59% vs 40%, P = .006). Between AC and AG-treated EFIE patients, there were no differences in mortality while on antimicrobial treatment (22% vs 21%, P = .81) or at 3-month follow-up (8% vs 7%, P = .72), in treatment failure requiring a change in antimicrobials (1% vs 2%, P = .54), or in relapses (3% vs 4%, P = .67). However, interruption of antibiotic treatment due to adverse events was much more frequent in AG-treated patients than in those receiving AC (25% vs 1%, P <.001), mainly due to new renal failure (>= 25% increase in baseline creatinine concentration; 23% vs 0%, P <.001).
Conclusions. AC appears as effective as AG for treating EFIE patients and can be used with virtually no risk of renal failure and regardless of the high-level aminoglycoside resistance status of E. faecalis.
Filiaciones:
Fernandez-Hidalgo, N:
Hosp Univ Vall dHebron, Serv Malalties Infeccioses, Barcelona 08035, Spain
Almirante, B:
Hosp Univ Vall dHebron, Serv Malalties Infeccioses, Barcelona 08035, Spain
Gavalda, J:
Hosp Univ Vall dHebron, Serv Malalties Infeccioses, Barcelona 08035, Spain
Gurgui, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Unitat Malalties Infeccioses, Dept Med, E-08193 Barcelona, Spain
Pena, C:
Hosp Univ Bellvitge, Serv Malalties Infeccioses, Barcelona, Spain
de Alarcon, A:
Hosp Univ Virgen Rocio, Serv Enfermedades Infecciosas & Med Interna, Seville, Spain
Ruiz, J:
Hosp Univ Virgen Victoria, Unidad Gest Clin Enfermedades Infecciosas, Malaga, Spain
Vilacosta, I:
Hosp Clin San Carlos, Serv Cardiol, Inst Cardiovasc, Madrid, Spain
Montejo, M:
Hosp Univ Cruces, Unidad Enfermedades Infecciosas, Bizkaia, Spain
Vallejo, N:
Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Barcelona, Spain
Lopez-Medrano, F:
Hosp Univ 12 Octubre, Unidad Enfermedades Infecciosas, Madrid, Spain
Plata, A:
Hosp Univ Carlos Haya, Serv Enfermedades Infecciosas, Malaga, Spain
Lopez, J:
Hosp Clin Univ, Inst Ciencias Corazon ICICOR, Valladolid, Spain
Hidalgo-Tenorio, C:
Hosp Univ Virgen las Nieves, Med Interna Serv, Granada, Spain
Galvez, J:
Hosp Univ Virgen Macarena, Secc Enfermedades Infecciosas, Seville, Spain
Saez, C:
Hosp Univ Princesa, Secc Enfermedades Infecciosas, Madrid, Spain
Lomas, JM:
Hosp Juan Ramon Jimenez, Unidad Enfermedades Infecciosas, Huelva, Spain
Falcone, M:
Policlin Umberto 1, Dept Infect Dis, Rome, Italy
de la Torre, J:
Hosp Costa Sol, Unidad Enfermedades Infecciosas, Malaga, Spain
Martinez-Lacasa, X:
Hosp Univ Mutua Terrassa, Unitat Malalties Infeccioses, Barcelona, Spain
Pahissa, A:
Hosp Univ Vall dHebron, Serv Malalties Infeccioses, Barcelona 08035, Spain
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