25 years of experience on the management of enterococcal infective endocarditis an observational study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2024-10-15 DOI:10.1007/s15010-024-02407-6

Lorenz Schubert, Rui-Yang Chen, Matthias Weiss-Tessbach, Richard Kriz, Markus Obermüller, Matthias Jackwerth, Wolfgang Barousch, Heinz Burgmann, Manuel Kussmann, Ludwig Traby

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引用次数: 0

Abstract

Purpose: As they are effective and well tolerated, aminopenicillins are still the cornerstone for the treatment of enterococcal infections. Current treatment guidelines for infective endocarditis (IE) recommend combination treatments, which carry a higher risk of adverse effects and are based on limited in vitro and experimental data. The aim of this study was therefore to evaluate the treatments of enterococcal IE in real-life practice.

Methods: A total of 4121 episodes of enterococcal bloodstream infections, occurring between 1994 and 2019, were screened for the evidence of IE. Baseline characteristics, risk factors for complicated infections and treatment information were assessed and analyzed using Cox regression analysis.

Results: Overall, 80 (3.9%) IE episodes were identified of which 78 were included in the final analysis. Treatment regimens in our cohort comprised aminopenicillin-monotherapy (n = 20), teicoplanin-monotherapy (n = 26), other monotherapies (OMT) (n = 8), as well as combinations of ampicillin plus daptomycin (n = 8), ampicillin plus gentamicin (n = 4) or other combinations (n = 9). Overall mortality at 28-days was low (9 of 75) and increased to (19 of 75) after 6-months. Frequency of moderate to severe valve regurgitation (p = 0.89), or signs of uncontrolled infection (p = 0.5) and vegetation size ≥ 10 mm (p = 0.11) were similar in the treatment groups. None of the treatment groups was associated with increased hazard for IE-related mortality.

Conclusions: This retrospective study complements previous evidence, demonstrating that monotherapy regimens may be a suitable and effective option for the treatment of IE and supports the need for a prospective evaluation of aminopenicillin-monotherapy for initial and subsequent therapy in these patients.

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肠球菌感染性心内膜炎 25 年管理经验观察研究。

目的：氨基青霉素类药物疗效好、耐受性好，因此仍是治疗肠球菌感染的基石。目前的感染性心内膜炎（IE）治疗指南推荐联合治疗，但联合治疗产生不良反应的风险较高，而且所依据的体外和实验数据有限。因此，本研究旨在评估现实生活中治疗肠球菌 IE 的方法：方法：对 1994 年至 2019 年期间发生的 4121 例肠球菌血流感染病例进行了筛查，以寻找 IE 的证据。采用 Cox 回归分析法对基线特征、复杂感染的风险因素和治疗信息进行评估和分析：共发现 80 例（3.9%）IE，其中 78 例纳入最终分析。队列中的治疗方案包括氨苄青霉素单药治疗（20例）、替考拉宁单药治疗（26例）、其他单药治疗（8例）以及氨苄青霉素加达托霉素（8例）、氨苄青霉素加庆大霉素（4例）或其他组合（9例）。28天的总死亡率较低（75例中有9例），6个月后增至（75例中有19例）。中度至重度瓣膜反流（p = 0.89）或感染失控迹象（p = 0.5）以及植被大小≥ 10 mm（p = 0.11）的发生率在治疗组中相似。所有治疗组都不会增加与IE相关的死亡率：这项回顾性研究补充了之前的证据，证明单药治疗方案可能是治疗 IE 的一种合适而有效的选择，并支持对氨青霉素-单药治疗进行前瞻性评估的必要性，以用于这些患者的初始治疗和后续治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.