Schubert Lorenz, Chen Rui-Yang, Weiss-Tessbach Matthias, Kriz Richard, Obermüller Markus, Jackwerth Matthias, Barousch Wolfgang, Burgmann Heinz, Kussmann Manuel, Traby Ludwig
Department of Medicine I, Clinical Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria.
Medical Department with Nephrology & Dialysis, Klinik Ottakring Vienna, Vienna, Austria.
Infection. 2025 Feb;53(1):467-474. doi: 10.1007/s15010-024-02407-6. Epub 2024 Oct 15.
As they are effective and well tolerated, aminopenicillins are still the cornerstone for the treatment of enterococcal infections. Current treatment guidelines for infective endocarditis (IE) recommend combination treatments, which carry a higher risk of adverse effects and are based on limited in vitro and experimental data. The aim of this study was therefore to evaluate the treatments of enterococcal IE in real-life practice.
A total of 4121 episodes of enterococcal bloodstream infections, occurring between 1994 and 2019, were screened for the evidence of IE. Baseline characteristics, risk factors for complicated infections and treatment information were assessed and analyzed using Cox regression analysis.
Overall, 80 (3.9%) IE episodes were identified of which 78 were included in the final analysis. Treatment regimens in our cohort comprised aminopenicillin-monotherapy (n = 20), teicoplanin-monotherapy (n = 26), other monotherapies (OMT) (n = 8), as well as combinations of ampicillin plus daptomycin (n = 8), ampicillin plus gentamicin (n = 4) or other combinations (n = 9). Overall mortality at 28-days was low (9 of 75) and increased to (19 of 75) after 6-months. Frequency of moderate to severe valve regurgitation (p = 0.89), or signs of uncontrolled infection (p = 0.5) and vegetation size ≥ 10 mm (p = 0.11) were similar in the treatment groups. None of the treatment groups was associated with increased hazard for IE-related mortality.
This retrospective study complements previous evidence, demonstrating that monotherapy regimens may be a suitable and effective option for the treatment of IE and supports the need for a prospective evaluation of aminopenicillin-monotherapy for initial and subsequent therapy in these patients.
由于氨基青霉素疗效显著且耐受性良好，它们仍是治疗肠球菌感染的基石。目前感染性心内膜炎（IE）的治疗指南推荐联合治疗，但这种治疗方式不良反应风险较高，且依据的体外和实验数据有限。因此，本研究旨在评估现实临床实践中肠球菌性IE的治疗方法。
对1994年至2019年间发生的4121例肠球菌血流感染病例进行筛查，以寻找IE证据。使用Cox回归分析评估并分析基线特征、复杂感染的危险因素及治疗信息。
总体而言，共识别出80例（3.9%）IE病例，其中78例纳入最终分析。我们队列中的治疗方案包括氨基青霉素单药治疗（n = 20）、替考拉宁单药治疗（n = 26）、其他单药治疗（OMT）（n = 8），以及氨苄西林联合达托霉素（n = 8）、氨苄西林联合庆大霉素（n = 4）或其他联合治疗（n = 9）。28天的总体死亡率较低（75例中有9例），6个月后升至（75例中有19例）。治疗组中中度至重度瓣膜反流的发生率（p = 0.89）、未控制感染的体征（p = 0.5）以及赘生物大小≥10 mm的发生率（p = 0.11）相似。没有一个治疗组与IE相关死亡率的风险增加有关。
这项回顾性研究补充了先前的证据，表明单药治疗方案可能是治疗IE的合适且有效的选择，并支持对这些患者初始及后续治疗采用氨基青霉素单药治疗进行前瞻性评估的必要性。
