Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
Clin Infect Dis. 2023 Nov 11;77(9):1273-1281. doi: 10.1093/cid/ciad375.
Evidence supporting combination treatment with a beta-lactam plus an aminoglycoside (C-BA) for endocarditis caused by viridans and gallolyticus group streptococci (VGS-GGS) with intermediate susceptibility to penicillin (PENI-I) is lacking. We assessed the clinical characteristics and outcomes of PEN-I VGS-GGS endocarditis and compared the effectiveness and safety of C-BA with third-generation cephalosporin monotherapy.
Retrospective analysis of prospectively collected data of a cohort of definite endocarditis caused by penicillin-susceptible and PENI-I VGS-GGS (penicillin minimum inhibitory concentration ranging from 0.25 to 2 mg/L) between 2008 and 2018 in 40 Spanish hospitals. We compared cases treated with monotherapy or with C-BA and performed multivariable analyses of risk factors for in-hospital and 1-year mortality.
A total of 914 consecutive cases of definite endocarditis caused by VGS-GGS with complete or intermediate susceptibility to penicillin were included. A total of 688 (75.3%) were susceptible to penicillin and 226 (24.7%) were PENI-I. Monotherapy was used in 415 (45.4%) cases (cephalosporin in 331 cases) and 499 (54.6%) cases received C-BA. In-hospital mortality was 11.9%, and 190 (20.9%) patients developed acute kidney injury. Heart failure (odds ratio [OR]: 6.06; 95% confidence interval [CI]: 1.37-26.87; P = .018), central nervous system emboli (OR: 9.83; 95% CI: 2.17-44.49; P = .003) and intracardiac abscess (OR: 13.47; 95% CI: 2.24-81.08; P = .004) were independently associated with in-hospital mortality among PEN-I VGS-GGS cases, while monotherapy was not (OR: 1.01; 95% CI: .26-3.96; P = .982).
Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.
对于青霉素中介度敏感的草绿色链球菌和牛链球菌（PENI-I）引起的心内膜炎，缺乏联合使用β-内酰胺类和氨基糖苷类药物（C-BA）治疗的证据。我们评估了 PENI-I 草绿色链球菌和牛链球菌心内膜炎的临床特征和结局，并比较了 C-BA 与第三代头孢菌素单药治疗的有效性和安全性。
对 2008 年至 2018 年期间 40 家西班牙医院前瞻性收集的青霉素敏感和 PENI-I 草绿色链球菌和牛链球菌（青霉素最小抑菌浓度范围为 0.25 至 2mg/L）引起的明确心内膜炎患者的队列数据进行回顾性分析。我们比较了接受单药治疗和 C-BA 治疗的病例，并对住院和 1 年死亡率的危险因素进行了多变量分析。
共纳入 914 例青霉素中介度敏感的草绿色链球菌和牛链球菌引起的明确心内膜炎连续病例，其中 688 例（75.3%）对青霉素完全敏感，226 例（24.7%）为 PENI-I。单药治疗 415 例（45.4%）（头孢菌素 331 例），C-BA 治疗 499 例（54.6%）。住院死亡率为 11.9%，190 例（20.9%）患者发生急性肾损伤。心力衰竭（比值比 [OR]：6.06；95%置信区间 [CI]：1.37-26.87；P =.018）、中枢神经系统栓塞（OR：9.83；95% CI：2.17-44.49；P =.003）和心内脓肿（OR：13.47；95% CI：2.24-81.08；P =.004）是 PENI-I 草绿色链球菌和牛链球菌心内膜炎患者住院死亡率的独立相关因素，而单药治疗并非如此（OR：1.01；95% CI：.26-3.96；P =.982）。
我们的研究结果支持在 PENI-I 草绿色链球菌和牛链球菌心内膜炎中使用头孢菌素单药治疗，以避免肾毒性而不影响患者结局。
