Ampicillin Plus Ceftriaxone Is as Effective as Ampicillin Plus Gentamicin for Treating Enterococcus faecalis Infective Endocarditis

TLDR: 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.