Division of Infectious Diseases, MayoClinic, Rochester, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Infectious Diseases, MayoClinic, Rochester, MN, USA.
J Infect. 2018 Nov;77(5):398-404. doi: 10.1016/j.jinf.2018.06.013. Epub 2018 Jun 30.
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.
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.
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).
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.
在治疗青霉素敏感的粪肠球菌感染性心内膜炎（EFIE）时，双联β-内酰胺类药物治疗和青霉素-氨基糖苷类药物联合治疗是一线治疗方案。我们的目的是比较氨苄西林联合头孢曲松（A+C）与氨苄西林联合庆大霉素（A+G）在 EFIE 治疗中的效果。
这是一项在明尼苏达州罗切斯特市和亚利桑那州凤凰城的梅奥诊所院区诊断为 EFIE 的成年（≥18 岁）患者的回顾性队列研究，这些患者接受 A+C 或 A+G 治疗。主要观察指标为 1 年死亡率、肾毒性和 EFIE 复发率。
本研究共纳入 85 例 EFIE 患者。大多数（n=67，79%）患者接受 A+G 治疗，18 例（21%）患者接受 A+C 作为初始治疗。入院时，接受 A+C 的患者Charlson 合并症指数较高（中位数[IQR]，4[3，4 比 2[1，4]；P=.008），基线血清肌酐较高（中位数[IQR]，1.2[0.9，1.6]比 0.9[0.8，1.2]mg/dL，P=.020）。两组 1 年死亡率相似，分别为 17%和 17%，P=.982。每组各有 1 例 EFIE 复发。接受 A+G 治疗的患者在治疗结束时的肾功能结果更差，表现为血清肌酐升高幅度更大（中位数[IQR]差值，+0.4[0.2，0.8]比-0.2[-0.3，0.1]mg/dL，P≤.001）。
A+C 似乎是治疗 EFIE 的一种安全有效的方案。与 A+G 组相比，接受 A+C 治疗的患者肾毒性发生率较低，复发率和 1 年死亡率无差异。
