Infectious Disease Unit, Auckland City Hospital, Auckland, New Zealand.
Infectious Disease Service, Nelson Bays Primary Health, Nelson, New Zealand.
J Antimicrob Chemother. 2021 Jul 15;76(8):2168-2171. doi: 10.1093/jac/dkab132.
Treatment regimens requiring multiple daily dosing for enterococcal endocarditis are challenging to deliver in the outpatient setting. Continuous-infusion benzylpenicillin via a 24 h elastomeric infusor, combined with either once-daily gentamicin or ceftriaxone, requires only one nursing encounter daily and is commonly used in New Zealand.
To assess the therapeutic success and adverse antibiotic effects of these regimens.
A retrospective observational case series from multiple hospitals of patients aged 15 years or over with enterococcal endocarditis diagnosed between July 2013 and June 2019 who received at least 14 days of outpatient continuous-infusion benzylpenicillin combined with either gentamicin or ceftriaxone for synergy.
Forty-three episodes of enterococcal endocarditis in 41 patients met inclusion criteria. The primary synergy antibiotic was gentamicin in 20 episodes and ceftriaxone in 23 episodes. For the 41 initial treatment courses, 31 (76%) patients were cured, 3 (7%) patients developed relapsed endocarditis during or following antibiotic treatment and 7 (17%) patients continued with long-term suppressive oral amoxicillin following IV antibiotic treatment. There was no difference in the relapse rate between the two groups (P = 0.59). Seven (35%) adverse antibiotic effects were documented in the gentamicin group and none in the ceftriaxone group (P < 0.01). Two deaths (5%) occurred within the 6 month follow-up period.
Outpatient treatment of enterococcal endocarditis with continuous-infusion benzylpenicillin combined with either once-daily gentamicin or ceftriaxone following a period of inpatient treatment is usually effective. A significantly higher rate of adverse effects was seen with gentamicin, favouring ceftriaxone as the initial synergy antibiotic.
对于肠球菌性心内膜炎的治疗方案，需要每天多次给药，这在门诊环境下具有挑战性。通过 24 小时弹性输注器输注连续的苄星青霉素，联合每日一次的庆大霉素或头孢曲松，每天只需进行一次护理，在新西兰较为常用。
评估这些方案的治疗成功率和抗生素不良反应。
本研究为多中心回顾性观察性病例系列研究，纳入 2013 年 7 月至 2019 年 6 月期间在新西兰被诊断为肠球菌性心内膜炎且年龄在 15 岁及以上、接受至少 14 天门诊连续输注苄星青霉素联合庆大霉素或头孢曲松以协同作用的患者。
41 例患者的 43 例肠球菌性心内膜炎发作符合纳入标准。主要协同抗生素为庆大霉素的有 20 例，头孢曲松的有 23 例。在 41 例初始治疗疗程中，31 例（76%）患者治愈，3 例（7%）患者在抗生素治疗期间或之后发生复发心内膜炎，7 例（17%）患者在静脉用抗生素治疗后继续长期口服阿莫西林进行抑制治疗。两组的复发率无差异（P=0.59）。庆大霉素组有 7 例（35%）发生抗生素不良反应，头孢曲松组无不良反应（P<0.01）。在 6 个月的随访期间，有 2 例（5%）死亡。
在住院治疗后，门诊使用连续输注苄星青霉素联合每日一次的庆大霉素或头孢曲松治疗肠球菌性心内膜炎通常是有效的。庆大霉素的不良反应发生率明显更高，这支持头孢曲松作为初始协同抗生素。
