Brief Communication: Treatment of Enterococcus faecalis Endocarditis with Ampicillin plus Ceftriaxone

Gavaldá, Joan; Len, Óscar; Miró, José M.; Muñóz, Patricia; Montejo, Miguel; Alarcón, Arı́stides de; Torre-Cisneros, J; Peña, Carmen; Martínez-Lacasa, Xavier; Sarriá, Cristina; Bou, Germán; Aguado, José María; Navas, Enrique; Romeu, Joan; Marco, Francesc; Torres, Carmén; Tornos, Pilar; Planes, Ana María; Falcó, Vicenç; Almirante, Benito; Pahissa, Albert

doi:10.7326/0003-4819-146-8-200704170-00008

Cited by 182 publications

(143 citation statements)

References 16 publications

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“…Po pierwsze, w kilku badaniach kohortowych dotyczących IZW wywołanego E. faecelis, obejmujących setki przypadków, wykazano, że w przypadkach szczepów E. faecalis bez HLAR, ampicylina zastosowana łącznie z ceftriaksonem wykazuje podobną skuteczność co ampicylina podawana łącznie z gentamicyną. Leczenie jest również bezpieczniejsze, pozbawione ryzyka nefrotoksyczności [183][184][185]. Ponadto jest to schemat terapii z wyboru w leczeniu IZW wywołanego przez E. faecalis z HLAR.…”

Section: Enterococcus Sppunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

148

212

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Section: Enterococcus Sppunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

148

212

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“…In the present study, patients with HLAR E faecalis IE were excluded, but HLAR is a serious and increasing problem in enterococcal endocarditis, with reports indicating that up to 28% to 48% of patients 37,48 are affected. Decreasing aminoglycoside treatment duration is one important way to limit further the development of HLAR.…”

mentioning

confidence: 99%

Enterococcus faecalis Infective Endocarditis

et al. 2013

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Background-Because of the nephrotoxic effects of aminoglycosides, the Danish guidelines on infective endocarditis were changed in January 2007, reducing gentamicin treatment in enterococcal infective endocarditis from 4 to 6 weeks to only 2 weeks. In this pilot study, we compare outcomes in patients with Enterococcus faecalis infective endocarditis treated in the years before and after endorsement of these new recommendations. Methods and Results-A total of 84 consecutive patients admitted with definite left-sided E faecalis endocarditis in the period of 2002 to 2011 were enrolled. Forty-one patients were treated before and 43 patients were treated after January 1, 2007. There were no significant differences in baseline characteristics. At hospitalization, the 2 groups had similar estimated glomerular filtration rates of 66 and 75 mL/min (P=0.22). Patients treated before January 2007 received gentamicin for a significantly longer period (28 versus 14 days; P<0.001). The primary outcome, 1-year event-free survival, did not differ: 66% versus 69%, respectively (P=0.75). At discharge, the patients treated before 2007 had a lower estimated glomerular filtration rate (45 versus 66 mL/min; P=0.008) and a significantly greater decrease in estimated glomerular filtration rate (median, 11 versus 1 mL/min; P=0.009) compared with those treated after 2007. Conclusions-Our present pilot study suggests that the recommended 2-week treatment with gentamicin seems adequate and preferable in treating non-high-level aminoglycoside-resistant E faecalis infective endocarditis. The longer duration of gentamicin treatment is associated with worse renal function. Although the certainty of the clinical outcomes is limited by the sample size, outcomes appear to be no worse with the shorter treatment duration. Randomized, controlled studies are warranted to substantiate these results. Dahl et al Gentamicin in Enterococcal Endocarditis 1811 Methods DatabaseData from consecutive patients diagnosed with IE in 2 tertiary heart centers in Copenhagen, Denmark, were prospectively collected beginning on October 1, 2002. These 2 highly specialized university hospitals serve as the only referral centers for IE patients in the eastern part of Denmark and cover a catchment area of 2.4 million people. The diagnosis of IE was based on clinical, microbiological, and echocardiographic findings. Patients were enrolled in the database if they met the revised Duke criteria 25 of definite or possible IE. Patients with possible IE were included only if they received treatment as patients with definite IE. All data were collected with a standardized case report form with >250 variables, including demographics; medical history; physical examination findings; results of blood tests, including blood cultures; ECG; antibiotic use; surgical treatment; and findings of both transthoracic and transesophageal echocardiography. Duration of symptoms was defined as the time from the appearance of the first symptoms of IE (reported by the patient or his or her close famil...

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“…15 The results prompted animal models that demonstrated synergy of ampicillin plus ceftriaxone in experimental EFIE for both HLAR strains 16 and non-HLAR strains. 17 Shortly afterwards, Gavaldà et al 18 proved the preliminary efficacy of the combination in a multicenter, open-label study that evaluated 43 patients with EFIE (49% with HLAR strains and 51% non-HLAR strains) treated with ampicillin (2 g/4 h) and ceftriaxone (2 g/12 h). 18 Clinical cure rates were 71% and 73%, respectively, with 5% relapses.…”

mentioning

confidence: 99%

“…17 Shortly afterwards, Gavaldà et al 18 proved the preliminary efficacy of the combination in a multicenter, open-label study that evaluated 43 patients with EFIE (49% with HLAR strains and 51% non-HLAR strains) treated with ampicillin (2 g/4 h) and ceftriaxone (2 g/12 h). 18 Clinical cure rates were 71% and 73%, respectively, with 5% relapses. The study by Fernández-Hidalgo et al 14 was an observational, nonrandomized, comparative, multicenter cohort study including 159 patients treated with ampicillin plus ceftriaxone (32% HLAR strains) and 87 patients treated with ampicillin plus gentamicin (all non-HLAR strains; Table).…”

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confidence: 99%

A New Era for Treating Enterococcus faecalis Endocarditis

2013

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E nterococci are the third most common etiologic agent of infective endocarditis worldwide after staphylococci and streptococci and cause 10% to 15% of cases.1 Enterococcal infections are increasingly relevant, especially among the elderly and patients with comorbid conditions in the healthcare setting.2,3 Approximately 90% of cases of enterococcal endocarditis are caused by Enterococcus faecalis, with <5% caused by E. faecium.2,3 The morbidity and mortality of enterococcal endocarditis are high. The percentage of patients requiring cardiac surgery (42%) and the 1-year mortality rate (29%) have remained almost unchanged for the last 30 years; recent data show that they may even be increasing.

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Brief Communication: Treatment of Enterococcus faecalis Endocarditis with Ampicillin plus Ceftriaxone

Abstract: The combination of ampicillin and ceftriaxone is effective and safe for treating HLAR E. faecalis endocarditis and could be a reasonable alternative for patients with non-HLAR E. faecalis endocarditis who are at increased risk for nephrotoxicity.

Cited by 182 publications

References 16 publications

2015 ESC Guidelines for the management of infective endocarditis

2015 ESC Guidelines for the management of infective endocarditis

Enterococcus faecalis Infective Endocarditis

A New Era for Treating Enterococcus faecalis Endocarditis

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