Efficacy and safety of antistaphylococcal penicillin or cephazolin-based combinations versus monotherapy for methicillin-susceptible Staphylococcus aureus infective endocarditis: A propensity score analysis of nationwide prospective cohort
Por:
Calderón-Parra, J, Grillo, S, Muñoz, P, Machado-Vilchez, M, Delgado-Montero, A, De Alarcón-González, A, Poyato-Borrego, M, Goenaga-Sánchez, M, Fariñas-Alvarez, MC, Miró, JM, López-Cortés, LE, Rodríguez-García, R, Oteo, JA, Martínez-Ramos, A
Publicada:
1 dic 2024
Resumen:
Objectives: We aimed to evaluate the usefulness of antistaphylococcal penicillin (ASP) or cephazolin-based combinations versus monotherapy in patients with native-valve infective endocarditis (IE) caused by methicillin-susceptible Staphylococcus aureus (MSSA). Methods: Post-hoc analysis of a multicentre prospective cohort. We include patients from 2008 to 2022 with definite native-valve, left-side IE due to MSSA treated primarily with ASP/cephazolin. Patients were categorized according to whether they initially received monotherapy or combination therapy for more than 72 h. A propensity score-matched cohort was planned. Results: Out of 420 included cases, 94 (22.4%) received monotherapy and 326 (77.6%) combination. Median combination duration was 14 days (interquartile range 10-20). Sixty-eight combination cases were matched with 68 monotherapy controls. Baseline characteristics were well balanced. There were no differences in in-hospital or one-year mortality between groups (OR 0.85, 95%CI 0.33-2.18 and HR 0.68, 95%CI 0.35-1.31, respectively). Endocarditis relapses and persistent bacteraemia rates were similar (0% vs 1.5%, p = 1.000; and 19.1% vs 13.2%, p = 0.352, respectively). Drug- related adverse events were more frequent in the combination group (15.0% vs 1.1%, p < 0.001). Conclusions: Antibiotic combinations for patients with native valve left-sided MSSA endocarditis did not improve patient's outcomes. Drug-related adverse events were more frequent in combination patients. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Calderón-Parra, J:
Univ Hosp Puerta Hierro, Internal Med Dept, Infect Dis Unit, Majadahonda, Madrid, Spain
Res Inst Puerta Hierro Segovia Arana IDIPHSA, Majadahonda, Spain
Grillo, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Infect Dis Unit, Barcelona, Spain
Muñoz, P:
Univ Hosp Gregorio Maranon, Infect Dis Dept, Madrid, Spain
Univ Complutense Madrid, Hlth Res Inst Gregorio Maranon, Fac Med, CIBER Resp Dis CIBERES CB06 06 0058, Madrid, Spain
Machado-Vilchez, M:
Univ Hosp Gregorio Maranon, Infect Dis Dept, Madrid, Spain
Univ Complutense Madrid, Hlth Res Inst Gregorio Maranon, Fac Med, CIBER Resp Dis CIBERES CB06 06 0058, Madrid, Spain
Delgado-Montero, A:
Univ Hosp Gregorio Maranon, Cardiol Dept, Madrid, Spain
CIBER Cardiovasc Dis CIBERCV, Valencia, Spain
De Alarcón-González, A:
Univ Hosp Virgen Rocio, Clin Unit Infect Dis Microbiol & Parasitol, Seville, Spain
Hlth Inst Carlos III, CIBER Infect Dis CIBERINFEC, Madrid, Spain
Biomed Inst Sevilla IBiS, Seville, Spain
Poyato-Borrego, M:
Univ Hosp Virgen Rocio, Clin Unit Infect Dis Microbiol & Parasitol, Seville, Spain
Hlth Inst Carlos III, CIBER Infect Dis CIBERINFEC, Madrid, Spain
Biomed Inst Sevilla IBiS, Seville, Spain
Goenaga-Sánchez, M:
Univ Hosp Donosti, ISS Bodonostia, Infect Dis Dept, San Sebastian, Spain
Fariñas-Alvarez, MC:
Univ Hosp Marques Valdecilla, Infect Dis Dept, Santander, Spain
Hlth Inst Carlos III, CIBER Infect Dis CIBERINF CB21 13 00 068, Madrid, Spain
Miró, JM:
Univ Barcelona, Hosp Clin, Infect Dis Dept, Barcelona, Spain
CIBERINFEC Res Inst Carlos III, Madrid, Spain
López-Cortés, LE:
Univ Hosp Virgen Macarena, Clin Infect Dis & Microbiol Dept, Seville, Spain
Univ Seville, CSIC, Inst Biomed Sevilla IBiS, CSIC,CIBERINFEC, Seville, Spain
Rodríguez-García, R:
Univ Hosp Cent Asturias, Intens Med Dept, Oviedo, Spain
Oteo, JA:
Univ Hosp San Pedro, Infect Dis Dept, Logrono, Spain
Biomed Invest Ctr La Rioja CIBIR, Logrono, Spain
Martínez-Ramos, A:
Univ Hosp Puerta Hierro, Internal Med Dept, Infect Dis Unit, Majadahonda, Madrid, Spain
Res Inst Puerta Hierro Segovia Arana IDIPHSA, Majadahonda, Spain
Univ Autonoma Madrid, Dept Med, Madrid, Spain
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