Vigneswaran N, McKew G
Department of Infectious Diseases and Microbiology, Concord Repatriation General Hospital, Sydney, Australia.
University of Sydney, Sydney, Australia.
JAC Antimicrob Resist. 2022 Sep 30;4(5):dlac096. doi: 10.1093/jacamr/dlac096. eCollection 2022 Oct.
A synergistic antibiotic combination of a penicillin and gentamicin (AG) or ceftriaxone (AC) is used in the management of infective endocarditis (EFIE). We compare the treatment outcomes between AG and AC, including low and high dose ceftriaxone (1 and 2 g 12 hourly).
A retrospective cohort study of patients treated for EFIE at single tertiary centre (2012-2019). Outcome measures examined were 90- and 180-day mortality, treatment associated adverse events and relapse of bacteraemia (within 1 year).
39 patients were enrolled [61.6% given (AC) (= 24), 24% received AC (= 10) and 34% received AC ( = 14)], 38.4% received AG (= 15). We noted a difference in the mortality outcomes at 90 and 180 days between those treated with AG and AC overall (6.7% and 33.3%, respectively) although this did not reach statistical significance ( = 0.114, = 0.061). No significant difference was noted between these groups in incidence of relapsed bacteraemia with two cases noted in the AC cohort (8.3%, 2/24) and none observed (0/15) in the AG cohort ( = 0.662, = 0.414). A greater number of adverse events was observed in the AG group (11/15, 73.3%) compared to the overall AC group (6/24, 25.0%) ( = 0.009), with no difference between the high and low dose ceftriaxone groups ( = 0.05).
Combination treatment of EFIE with AC is associated with a reduced number of adverse events in comparison to AG groups. Although increased mortality was observed in the AC group, this did not reach statistical significance, and reflects the greater comorbidities and reduced capacity for surgical source control in this cohort.
青霉素与庆大霉素（AG）或头孢曲松（AC）的协同抗生素组合用于感染性心内膜炎（EFIE）的治疗。我们比较了AG和AC之间的治疗结果，包括低剂量和高剂量头孢曲松（每12小时1克和2克）。
对在单一三级中心接受EFIE治疗的患者进行回顾性队列研究（2012 - 2019年）。检查的结果指标为90天和180天死亡率、治疗相关不良事件以及菌血症复发（1年内）。
共纳入39例患者[61.6%接受（AC）（=24例），24%接受AC（=10例），34%接受AC（=14例）]，38.4%接受AG（=15例）。我们注意到总体上接受AG和AC治疗的患者在90天和180天的死亡率存在差异（分别为6.7%和33.3%），尽管这未达到统计学显著性（=0.114，=0.061）。这些组之间菌血症复发率无显著差异，AC队列中有2例（8.3%，2/24），AG队列中未观察到（0/15）（=0.662，=0.414）。与总体AC组（6/24，25.0%）相比，AG组观察到更多不良事件（11/15，73.3%）（=0.009），高剂量和低剂量头孢曲松组之间无差异（=0.05）。
与AG组相比，AC联合治疗EFIE的不良事件数量减少。尽管AC组观察到死亡率增加，但未达到统计学显著性，这反映了该队列中合并症更多以及手术源控制能力降低。
