Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis
Por:
Ramos-Martinez, A, Serrano, AM, Gonzalez, AD, Munoz, P, Fernandez-Cruz, A, Valerio, M, Farinas, MC, Gutierrez-Cuadra, M, Ma, J, Miro, Ruiz-Morales, J, Sousa-Regueiro, D, Montejo, JM, Galvez-Acebal, J, HidalgoTenorio, C, Dominguez, F, Benito N., Gurgui M., Porres, Juan Carlos
Publicada:
1 jul 2018
Resumen:
Purpose: To analyze the influence of adding gentamicin to a regimen consisting of beta-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE).
Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on beta-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin.
Results: Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis.
Conclusions: The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome. (c) 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Filiaciones:
Ramos-Martinez, A:
Univ Puerta de Hierro, Serv Med Interna, Unidad Enfermedades Infecciosas, Majadahonda, Spain
Univ Autonoma Madrid, Madrid, Spain
Serrano, AM:
Hosp Univ Puerta de Hierro, Serv Med Interna, Madrid, Spain
Gonzalez, AD:
Univ Virgen del Rocio & Virgen Macarena, Univ Sevilla, Grp Invest Enfermedades Infecciosas, Inst Biomed Sevilla IBIS,CSIC,Unidad Clin Enferme, Seville, Spain
Munoz, P:
Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
Univ Complutense Madrid, CIBER Enfermedades Resp CIBERES CB06 06 0058, Inst Invest Sanit Gregorio Maranon, Fac Med, Madrid, Spain
Fernandez-Cruz, A:
Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
Inst Invest Sanit Gregorio Maranon, Madrid, Spain
Valerio, M:
Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
Inst Invest Sanit Gregorio Maranon, Madrid, Spain
Farinas, MC:
Univ Cantabria, Hosp Univ Marques de Valdecilla, Unidad Enfermedades Infecciosas, Santander, Spain
Gutierrez-Cuadra, M:
Hosp Univ Marques de Valdecilla, Unidad Enfermedades Infecciosas, Santander, Spain
Ma, J:
Univ Puerta de Hierro, Serv Med Interna, Unidad Enfermedades Infecciosas, Majadahonda, Spain
Univ Autonoma Madrid, Madrid, Spain
Miro:
Univ Barcelona, Hosp Clin IDIBAPS, Serv Enfermedades Infecciosas, Barcelona, Spain
Ruiz-Morales, J:
Hosp Clin Univ Virgen de la Victoria, IBIMA, Unidad Gest Clin Enfermedades Infecciosas, Malaga, Spain
Sousa-Regueiro, D:
Complejo Hosp A Coruna, Serv Enfermedades Infecciosas, La Coruna, Spain
Montejo, JM:
Hosp Univ Cruces, Unidad Enfermedades Infecciosas, Bilbao, Spain
Univ Basque Country, Pais Vasco, Spain
Galvez-Acebal, J:
Univ Seville, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Inst Biomed Sevilla,IBIS, Seville, Spain
HidalgoTenorio, C:
Complejo Hosp Granada, Hosp Univ Virgen de las Nieves, Serv Enfermedades Infecciosas, Granada, Spain
Dominguez, F:
Hosp Univ Puerta de Hierro, Serv Cardiol, Madrid, Spain
Benito N.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Gurgui M.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Porres, Juan Carlos:
Hospital Universitario Miguel Servet, Zaragoza, Spain
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