Escrihuela-Vidal Francesc, Fernández-Hidalgo Núria, Muñoz Patricia, Villamarín Miguel, Jiménez García Nicolás, Escudero Encarnación Moral, Martínez Marcos Francisco Javier, Cuervo Guillermo, Boix-Palop Lucía, Berbel Dámaris, Carratalà Jordi, Miró Jose M
Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Passeig de la Vall d'Hebron 119-129, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Antimicrob Chemother. 2024 Dec 2;79(12):3230-3235. doi: 10.1093/jac/dkae345.
Infective endocarditis (IE) caused by viridans and gallolyticus group streptococci (VGS-GGS) resistant to penicillin (PEN-R; minimum inhibitory concentration ≥4 mg/L) is rare but poses therapeutic challenges.
To describe the characteristics of patients with IE caused by PEN-R VGS-GGS, focusing on antimicrobial management.
Retrospective analysis of a prospective cohort of definite IE caused by PEN-R VGS-GGS between 2008 and 2023 in 40 Spanish hospitals. We describe clinical characteristics, management and outcome of the cases, and compare them to IE caused by VGS-GGS with susceptibility or susceptibility with increased exposure to penicillin (PEN-I).
We identified nine cases of PEN-R VGS-GGS IE in a cohort of 1563 streptococcal IE (0.58%). All isolates belonged to S. mitis group. Three cases died during hospitalization and no relapse occurred at 3 months of follow-up. Compared to cases with susceptibility or PEN-I, PEN-R showed a higher rate of mitral location (78% versus 51%), surgical indication (67% versus 51%), and in-hospital mortality (33% versus 12%). Most cases (86%) showed resistance to third-generation cephalosporins. The preferred antibiotic regimen was beta-lactam-based: ceftriaxone plus gentamicin, penicillin plus gentamicin, ceftriaxone plus levofloxacin, and ceftaroline plus daptomycin. Two cases received a combination of vancomycin plus gentamicin. Levofloxacin was used in two cases in combination with ceftriaxone or daptomycin. All patients that received cardiac surgery were cured at the end of follow-up.
IE caused by PEN-R VGS-GGS was rare and only affected mitis group streptococci. Antibiotic combination including a beta-lactam seems to be effective in its management.
由对青霉素耐药（PEN-R；最低抑菌浓度≥4mg/L）的草绿色链球菌和解脲链球菌属（VGS-GGS）引起的感染性心内膜炎（IE）较为罕见，但带来了治疗挑战。
描述由PEN-R VGS-GGS引起的IE患者的特征，重点关注抗菌治疗管理。
对2008年至2023年间西班牙40家医院中由PEN-R VGS-GGS引起的确诊IE的前瞻性队列进行回顾性分析。我们描述了病例的临床特征、治疗管理和结局，并将其与由对青霉素敏感或因增加青霉素暴露而敏感的VGS-GGS引起的IE进行比较。
在1563例链球菌性IE队列中，我们确定了9例PEN-R VGS-GGS IE（0.58%）。所有分离株均属于缓症链球菌群。3例患者在住院期间死亡，随访3个月时无复发。与敏感或PEN-I病例相比，PEN-R病例二尖瓣受累率更高（78%对51%）、手术指征更高（67%对51%）和院内死亡率更高（33%对12%）。大多数病例（86%）对第三代头孢菌素耐药。首选的抗生素方案是以β-内酰胺类为基础：头孢曲松加庆大霉素、青霉素加庆大霉素、头孢曲松加左氧氟沙星、头孢洛林加达托霉素。2例患者接受了万古霉素加庆大霉素的联合治疗。2例患者使用左氧氟沙星联合头孢曲松或达托霉素。所有接受心脏手术的患者在随访结束时均治愈。
由PEN-R VGS-GGS引起的IE罕见，仅累及缓症链球菌群。包括β-内酰胺类的抗生素联合治疗似乎对其治疗有效。
