Comparison of Dual β-Lactam therapy to penicillin-aminoglycoside combination in treatment of Enterococcus faecalis infective endocarditis

Abdelghani El Rafei, Daniel C. DeSimone, Aalap D. Narichania, M. Rizwan Sohail, Holenarasipur R. Vikram, Zhuo Li, James M. Steckelberg, Walter R. Wilson, Larry M. Baddour

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background: Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE. Methods: This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates. Results: Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79%) of patients received A+G while 18 (21%) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17% vs. 17%, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [−0.3, 0.1] mg/dL, P≤.001). Conclusion: A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.

Original languageEnglish (US)
Pages (from-to)398-404
Number of pages7
JournalJournal of Infection
Volume77
Issue number5
DOIs
StatePublished - Nov 2018

Bibliographical note

Funding Information:
The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), and two Mayo Named Professorships - the Edward C. Rosenow III, M.D. Professorship in the Art of Medicine (W.R.W.), and the HH Sheikh Khalifa Bin Zayed Al-Nahyan Professorship in Infectious Diseases Honoring Walter R. Wilson, M.D. (L.M.B.), which were paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years.

Publisher Copyright:
© 2018 The British Infection Association

Keywords

  • Aminoglycoside
  • Ceftriaxone
  • Enterococcus faecalis
  • Infective endocarditis
  • β-lactam

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