联合治疗与单一疗法：肠球菌性心内膜炎抗生素治疗的回顾性分析
Combination therapy versus monotherapy: retrospective analysis of antibiotic treatment of enterococcal endocarditis.
作者信息
Saman Razan, Primus Christopher P, West Robert, Woldman Simon J, Sandoe Jonathan A T
机构信息
Medical Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK.
Imperial College Healthcare NHS Trust, Du Cane Road, W12 0HS, London, UK.
出版信息
BMC Infect Dis. 2025 Jan 20;25(1):92. doi: 10.1186/s12879-025-10451-2.
BACKGROUND
Guidelines suggest treating fully penicillin-susceptible Enterococcus faecalis strains causing infective endocarditis with amoxicillin combined with gentamicin or ceftriaxone, but clinical evidence to support this practice is limited and monotherapy cohorts were excluded from studies. We describe antibiotic treatment, complications, and outcomes in patients with Enterococcus faecalis infective endocarditis, specifically comparing monotherapy versus combination therapy.
METHODS
Retrospective analysis of prospectively collected cohort of patients with definite or possible infective endocarditis from 2 English centres between 2006 and 2021. The primary outcome was 30-day mortality. Secondary outcomes included acute kidney injury, relapse, and clinical cure.
RESULTS
178 individuals were included: median age was 72 years (interquartile range 60-79), male sex majority (138, 78%) and mostly native valve endocarditis (108, 61%). Thirty-nine patients (22%) received monotherapy (penicillin/glycopeptide/linezolid/daptomycin), 128 (72%) combination with gentamicin, 11 (6%) combination with ceftriaxone. Patients on combination therapy with gentamicin had a statistically significant lower 30-day mortality than those treated with monotherapy (21 (16.4%) versus 15 (38.5%) p = 0.035) and higher rates of clinical cure (101 (78.9%) versus 23 (59.0%) p = 0.018). Patient receiving gentamicin were more likely to experience acute kidney injury (64 (50%) versus 11 (28.2%) p = 0.057). Ceftriaxone combination was associated with poor outcomes, but the sample size was small.
CONCLUSION
Patients treated with combination gentamicin therapy had better clinical outcomes than patients treated with monotherapy. Low-dose gentamicin regimens were associated with acute kidney injury. Patients treated with combinations were different to those treated with monotherapy and confounding remains a concern with observational analyses. An adequately powered clinical trial is needed to determine optimal treatment of enterococcal endocarditis.
CLINICAL TRIAL NUMBER
Not applicable.
背景
指南建议使用阿莫西林联合庆大霉素或头孢曲松治疗引起感染性心内膜炎的对青霉素完全敏感的粪肠球菌菌株，但支持这种治疗方法的临床证据有限，且单药治疗队列被排除在研究之外。我们描述了粪肠球菌感染性心内膜炎患者的抗生素治疗、并发症及预后情况，特别比较了单药治疗与联合治疗。
方法
对2006年至2021年间来自2个英国中心的确诊或可能患有感染性心内膜炎患者的前瞻性队列进行回顾性分析。主要结局是30天死亡率。次要结局包括急性肾损伤、复发和临床治愈。
结果
共纳入178例患者：中位年龄为72岁（四分位间距60 - 79岁），男性居多（138例，78%），且大多为自体瓣膜心内膜炎（108例，61%）。39例患者（22%）接受单药治疗（青霉素/糖肽类/利奈唑胺/达托霉素），128例（72%）联合庆大霉素治疗，11例（6%）联合头孢曲松治疗。联合庆大霉素治疗的患者30天死亡率在统计学上显著低于接受单药治疗的患者（21例（16.4%）对15例（38.5%），p = 0.035），临床治愈率更高（101例（78.9%）对23例（59.0%），p = 0.018）。接受庆大霉素治疗的患者更易发生急性肾损伤（64例（50%）对11例（28.2%），p = 0.057）。联合头孢曲松治疗与不良预后相关，但样本量较小。
结论
联合庆大霉素治疗的患者临床结局优于单药治疗的患者。低剂量庆大霉素方案与急性肾损伤相关。接受联合治疗的患者与接受单药治疗的患者不同，观察性分析中仍存在混杂因素。需要开展一项有足够效力的临床试验来确定肠球菌性心内膜炎的最佳治疗方法。
临床试验编号
不适用。
Zotero 插件