Ramos-Martínez Antonio, Muñoz Serrano Alejandro, de Alarcón González Arístides, Muñoz Patricia, Fernández-Cruz Ana, Valerio Maricela, Fariñas María Carmen, Gutiérrez-Cuadra Manuel, Miró José Ma, Ruiz-Morales Josefa, Sousa-Regueiro Dolores, Montejo José Miguel, Gálvez-Acebal Juan, HidalgoTenorio Carmen, Domínguez Fernando
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
J Infect Chemother. 2018 Jul;24(7):555-562. doi: 10.1016/j.jiac.2018.03.003. Epub 2018 Apr 6.
To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE).
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 β-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.
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.
The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
分析在由β-内酰胺类或万古霉素加利福平组成的治疗方案中添加庆大霉素对葡萄球菌人工瓣膜心内膜炎（SPVE）患者生存率的影响。
2008年1月至2016年9月，参与研究的医院共收治了334例确诊为SPVE的患者。94例（28.1%）患者接受了基于β-内酰胺类或万古霉素加rifampicin的治疗，并被纳入研究。分析了与患者住院期间生存相关的变量，包括是否接受了庆大霉素治疗。
77例（81.9%）患者接受了氯唑西林（或万古霉素）加利福平加庆大霉素治疗，17例（18.1%）患者接受了相同方案但未加庆大霉素治疗。致病微生物为金黄色葡萄球菌40例（42.6%），凝固酶阴性葡萄球菌54例（57.4%）。总体而言，40例（42.6%）患者在住院期间死亡，接受庆大霉素治疗组有33例（42.9%），未接受庆大霉素治疗组有7例（41.2%，P = 0.899）。接受庆大霉素治疗的42例（54.5%）患者和未接受庆大霉素治疗的9例（52.9%）患者出现肾功能恶化（p = 0.904）。作为心内膜炎并发症的心力衰竭（比值比：4.58；95%置信区间：1.84 - 11.42）以及在有指征时未进行手术（比值比：2.68；95%置信区间：1.03 - 6.94）会增加死亡率。在多变量分析中，庆大霉素的使用与死亡率仍无关联（比值比：1.001；95%置信区间：0.29 - 3.38）。
在SPVE中，在包含万古霉素或氯唑西林加利福平的治疗方案中添加庆大霉素与更好的预后无关。
