Do Rego Hermann, Kherabi Yousra, Corvec Stephane, Plouzeau-Jayle Chloé, Bouchiat Coralie, Macheda Gabriel, Meyer Sylvain, Cattoir Vincent, Piau Caroline, Guillard Thomas, Zahar Jean-Ralph, Farfour Eric, Lecomte Raphaël, Amara Marlène, Isnard Christophe, Le Monnier Alban, Pilmis Benoit
Equipe Mobile de Microbiologie Clinique, Hôpitaux Saint-Joseph & Marie-Lannelongue, Paris, France.
Service de Bactériologie et des Contrôles Microbiologiques, CHU Nantes, Nantes Université INSERM INCIT U1302, Nantes, France.
JAC Antimicrob Resist. 2024 Nov 1;6(6):dlae167. doi: 10.1093/jacamr/dlae167. eCollection 2024 Dec.
The incidence of infective endocarditis is increasing over time. Data on the impact of minimum inhibitory concentration (MIC) of amoxicillin on treatment outcomes are scarce. The objective of this study was to describe the epidemiology of infective endocarditis and to evaluate whether the MIC of amoxicillin might influence mortality.
We retrospectively included all consecutive patients diagnosed with definite infective endocarditis between 2013 and 2020 in 11 French hospitals. We extracted data from the local diagnosis-related group (DRG) database and matched these data with microbiological results. Amoxicillin MIC was determined by Etest strip. The primary endpoints were endocarditis-related mortality and risk factors for endocarditis-related mortality including amoxicillin MIC.
A total of 403 patients with definite infective endocarditis were included. Patients were predominantly male (76.4%) with a median age of 74 years (67-82). Embolic complications occurred in 170 (42.1%) patients. Cardiac surgery was performed in 158 (61.5%) patients. The endocarditis-related mortality rate was 28.3% and the median delay between mortality and onset of hospitalization was 24 (9; 41) days. MIC of amoxicillin was available for 246 (61%) patients. The median MIC was 0.5 mg/L (0.4-0.7). Amoxicillin MIC was not found to be associated with in-hospital mortality. None of the variables included in the multivariate model were identified as a risk factor for mortality and there was no correlation between mortality and the duration of treatment for 4 weeks versus 6 weeks.
Higher amoxicillin MIC was not a risk factor leading to endocarditis-related mortality in definite infective endocarditis. However, further studies are needed to assess the effect of amoxicillin MIC on relapse.
感染性心内膜炎的发病率随时间呈上升趋势。关于阿莫西林最低抑菌浓度（MIC）对治疗结果影响的数据很少。本研究的目的是描述感染性心内膜炎的流行病学，并评估阿莫西林的MIC是否会影响死亡率。
我们回顾性纳入了2013年至2020年期间法国11家医院连续诊断为确诊感染性心内膜炎的所有患者。我们从当地诊断相关组（DRG）数据库中提取数据，并将这些数据与微生物学结果进行匹配。阿莫西林MIC通过Etest试纸条测定。主要终点是心内膜炎相关死亡率以及心内膜炎相关死亡率的危险因素，包括阿莫西林MIC。
共纳入403例确诊感染性心内膜炎患者。患者以男性为主（76.4%），中位年龄为74岁（67 - 82岁）。170例（42.1%）患者发生栓塞并发症。158例（61.5%）患者接受了心脏手术。心内膜炎相关死亡率为28.3%，死亡与住院开始之间的中位延迟为24（9；41）天。246例（61%）患者有阿莫西林MIC数据。中位MIC为0.5mg/L（0.4 - 0.7）。未发现阿莫西林MIC与住院死亡率相关。多变量模型中纳入的变量均未被确定为死亡危险因素，且死亡率与4周和6周治疗时长之间无相关性。
在确诊的感染性心内膜炎中，较高的阿莫西林MIC不是导致心内膜炎相关死亡率的危险因素。然而，需要进一步研究来评估阿莫西林MIC对复发的影响。
