Ampicillin Plus Ceftriaxone Is as Effective as Ampicillin Plus Gentamicin for Treating Enterococcus faecalis Infective Endocarditis
TL;DR: 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.
Abstract: (See the Editorial Commentary by Munita et al on pages 1269–72.) 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 AGtreated 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.
Citations
More filters
TL;DR: This document summarizes current knowledge about three-dimensional AIDS, congenital heart disease, cardiac device-related infective endocarditis, and cardiac implantable electronic device in the context of acquired immune deficiency syndrome.
Abstract: 3D
: three-dimensional
AIDS
: acquired immune deficiency syndrome
b.i.d.
: bis in die (twice daily)
BCNIE
: blood culture-negative infective endocarditis
CDRIE
: cardiac device-related infective endocarditis
CHD
: congenital heart disease
CIED
: cardiac implantable electronic device
3,510 citations
TL;DR: The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection and must be used to support and not supplant decisions in individual patient management.
Abstract: Background— Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex wit...
1,862 citations
Cites background or result from "Ampicillin Plus Ceftriaxone Is as E..."
...First, these are the largest series of E faecalis IE reported to date, 43 patients in 1 study(190) and 272 in the other study.(191) Second, high-level aminoglycoside-resistant E faecalis IE treated with ampicillin-ceftriaxone therapy was present in 50% of the patients in the smaller study and 33% of patients in the larger study....
[...]
...A large, multicenter study by Spanish and Italian investigators compared ampicillin-ceftriaxone with ampicillin-gentamicin therapy of E faecalis IE.(191) Patients with high-level aminoglycoside-resistant strains were not treated with ampicillin-gentamicin....
[...]
TL;DR: Authors/Task Force Members: Gilbert Habib* (Chairperson) (France), Patrizio Lancellotti* (co-Chair person) (Belgium), Manuel J. Antunes (Portugal), Maria Grazia Bongiorni (Italy), Jean-Paul Casalta (France) and Francesco Del Zotti (Italy).
Abstract: Authors/Task Force Members: Gilbert Habib* (Chairperson) (France), Patrizio Lancellotti* (co-Chairperson) (Belgium), Manuel J. Antunes (Portugal), Maria Grazia Bongiorni (Italy), Jean-Paul Casalta (France), Francesco Del Zotti (Italy), Raluca Dulgheru (Belgium), Gebrine El Khoury (Belgium), Paola Anna Erba (Italy), Bernard Iung (France), Jose M. Miro (Spain), Barbara J. Mulder (The Netherlands), Edyta Plonska-Gosciniak (Poland), Susanna Price (UK), Jolien Roos-Hesselink (The Netherlands), Ulrika Snygg-Martin (Sweden), Franck Thuny (France), Pilar Tornos Mas (Spain), Isidre Vilacosta (Spain), and Jose Luis Zamorano (Spain)
695 citations
TL;DR: A thorough understanding of the mechanisms underlying antibiotic resistance in enterococci is the first step for devising strategies to control the spread of these organisms and potentially establish novel therapeutic approaches.
Abstract: Multidrug-resistant (MDR) enterococci are important nosocomial pathogens and a growing clinical challenge. These organisms have developed resistance to virtually all antimicrobials currently used in clinical practice using a diverse number of genetic strategies. Due to this ability to recruit antibiotic resistance determinants, MDR enterococci display a wide repertoire of antibiotic resistance mechanisms including modification of drug targets, inactivation of therapeutic agents, overexpression of efflux pumps and a sophisticated cell envelope adaptive response that promotes survival in the human host and the nosocomial environment. MDR enterococci are well adapted to survive in the gastrointestinal tract and can become the dominant flora under antibiotic pressure, predisposing the severely ill and immunocompromised patient to invasive infections. A thorough understanding of the mechanisms underlying antibiotic resistance in enterococci is the first step for devising strategies to control the spread of these organisms and potentially establish novel therapeutic approaches.
466 citations
Cites background from "Ampicillin Plus Ceftriaxone Is as E..."
...Seemingly redundant therapy, such as the combination of the b-lactams, ampicillin and ceftriaxone, has been shown clinically to be as efficacious as more traditional combinations with aminoglycosides, with the benefit of less toxicity and the ability to bypass high-level resistance to aminoglycosides [133,134]....
[...]
TL;DR: The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
387 citations
Cites background from "Ampicillin Plus Ceftriaxone Is as E..."
...effective as ampicillin/gentamicin, with reduced levels of nephrotoxicity (94,95)....
[...]
References
More filters
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
39,961 citations
TL;DR: Modifications of the Duke criteria for the diagnosis of infective endocarditis are proposed, including that positive Q-fever serology should be changed to a major criterion and the minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated.
Abstract: Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of this schema remain. The Duke IE database contains records collected prospectively on >800 cases of definite and possible IE since 1984. Databases on echocardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained. Analyses of these databases, our experience with the Duke criteria in clinical practice, and analysis of the work of others have led us to propose the following modifications of the Duke schema. The category "possible IE" should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria. The minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated, given the widespread use of transesophageal echocardiography (TEE). Bacteremia due to S. aureus should be considered a major criterion, regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present. Positive Q-fever serology should be changed to a major criterion.
3,330 citations
TL;DR: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection, and Mortality remains relatively high.
Abstract: (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.131.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.643.09) were associated with an increased risk of inhospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. Conclusions: In the early 21st century, IE is more often an acute disease, characterized by a high rate ofS aureus infection. Mortality remains relatively high.
1,816 citations
TL;DR: The ESC Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means as mentioned in this paper.
Abstract: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously.
A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).
In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/ benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .
View this table:
Table 1
Classes of recommendations
View this table:
Table 2
Levels of evidence
The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified to …
1,658 citations
TL;DR: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).
Abstract: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).
1,574 citations