Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci

Medientyp: E-Artikel
Titel: Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci
Beteiligte: Escrihuela-Vidal, Francesc; Berbel, Damaris; Fernández-Hidalgo, Núria; Escolà-Vergé, Laura; Muñoz, Patricia; Olmedo, María; Goenaga, Miguel Ángel; Goikoetxea, Josune; Fariñas, María Carmen; De Alarcón, Arístides; Miró, José M; Ojeda, Guillermo; Plata, Antonio; Cuervo, Guillermo; Carratalà, Jordi; Sánchez, Fernando Fernández; de Lomas, José Mª García; Rosas, Gabriel; de la Torre Lima, Javier; Bereciartua, Elena; Vidal, María José Blanco; Blanco, Roberto; Boado, María Victoria; Lázaro, Marta Campaña; [...]
Erschienen: Oxford University Press (OUP), 2023
Erschienen in: Clinical Infectious Diseases
Sprache: Englisch
DOI: 10.1093/cid/ciad375
ISSN: 1058-4838; 1537-6591
Schlagwörter: Infectious Diseases ; Microbiology (medical)
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Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.</jats:p> </jats:sec>

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