Clinical outcomes of combination versus monotherapy for gram negative non-HACEK infective endocarditis

Lorenz, Ashley M; Sobhanie, Mohammad Mahdee; Orzel, Libby; Coe, Kelci E; Wardlow, Lynn

doi:10.1016/j.diagmicrobio.2021.115504

Cited by 14 publications

(9 citation statements)

References 12 publications

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“…Five patients in the aminoglycoside combination group experienced acute kidney injury compared to none in the monotherapy group ( p = 0.012). In spite of the small sample size and retrospective nature, this study provides an avenue to explore MT in patients with uncomplicated, non-HACEK, Gram-negative IE [ 101 ].…”

Section: Oral Antimicrobials For Iementioning

confidence: 99%

Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis

et al. 2023

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Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals’ experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction of new antimicrobials and novel combinations are exciting developments but also further complicate IE treatment choices. In this review, we provide and evaluate the relevant evidence focused around contemporary debates in IE treatment pharmacotherapy, including beta-lactam choice in MSSA IE, combination therapies (aminoglycosides, ceftaroline), the use of oral antimicrobials, the role of rifamycins, and long-acting lipoglycopeptides.

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Section: Oral Antimicrobials For Iementioning

confidence: 99%

Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis

et al. 2023

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“…Mechanisms of antimicrobial resistance in NGNB have increased dramatically across the planet [ 25 , 26 ], making this a public health issue [ 27 ]. A single-center retrospective study involving 60 patients with Gram-negative infective endocarditis, found by ICD coding in the years 2011 to 2019 in Ohio, USA, attempted to answer the query on whether combination therapy was superior to monotherapy [ 28 ]. The frequency of intravenous substance abuse was high, 21/60 (35%).…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of intravenous substance abuse was high, 21/60 (35%). There was no difference in 60-day mortality, which was 7/34 (21%) in patients who had monotherapy vs. 5/26 (19%) of those on combination therapy [ 28 ]. This publication had small numbers of patients and a retrospective design, which means severity of illness at presentation may have affected treatment allocation, as there was more intravenous drug use, CNS involvement and metastatic sites at baseline in the combination therapy group.…”

Section: Discussionmentioning

confidence: 99%

Infective Endocarditis due to Non-HACEK Gram-Negative Bacilli: Clinical Characteristics and Risk Factors from a Prospective Multicenter Brazilian Cohort

et al. 2023

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Background: Non-HACEK Gram-negative bacilli (NGNB) infective endocarditis (IE) has a growing frequency. We aimed to describe cases of NGNB IE and find associated risk factors. Methods: We conducted a prospective observational study of consecutive patients with definitive IE according to the modified Duke criteria in four institutions in Brazil. Results: Of 1154 adult patients enrolled, 38 (3.29%) had IE due to NGNB. Median age was 57 years, males predominated, accounting for 25/38 (65.8%). Most common etiologies were Pseudomonas aeruginosa and Klebsiella spp. (8 episodes, 21% each). Worsening heart failure occurred in 18/38 (47.4%). Higher prevalence of embolic events was found (55,3%), mostly to the central nervous system 7/38 (18.4%). Vegetations were most commonly on aortic valves 17/38 (44.7%). Recent healthcare exposure was found in 52.6% and a central venous catheter (CVC) in 13/38 (34.2%). Overall mortality was 19/38 (50%). Indwelling CVC (OR 5.93; 95% CI, 1.29 to 27.3; p = 0.017), hemodialysis (OR 16.2; 95% CI, 1.78 to 147; p = 0.008) and chronic kidney disease (OR 4.8; 95% IC, 1.2 to 19.1, p = 0.049) were identified as risk factors for mortality. Conclusions: The rate of IE due to NGNB was similar to that in previous studies. Enterobacterales and P. aeruginosa were the most common etiologies. NGNB IE was associated with central venous catheters, prosthetic valves, intracardiac devices and hemodialysis and had a high mortality rate.

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“…However, a majority of patients were treated with a beta-lactam and aminoglycoside [ 6 ]. A single-center retrospective cohort study by Lorenz et al evaluated a composite outcome of 60-day all-cause mortality, readmission, or recurrence of bacteremia comparing combination and monotherapy in 60 patients with non-HACEK gram-negative endocarditis [ 14 ]. There was no difference in the primary composite outcome between the monotherapy and combination therapy groups (62% vs 50%; P = .36) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…A single-center retrospective cohort study by Lorenz et al evaluated a composite outcome of 60-day all-cause mortality, readmission, or recurrence of bacteremia comparing combination and monotherapy in 60 patients with non-HACEK gram-negative endocarditis [ 14 ]. There was no difference in the primary composite outcome between the monotherapy and combination therapy groups (62% vs 50%; P = .36) [ 14 ]. A small retrospective review of 20 patients with non-HACEK gram-negative endocarditis demonstrated higher 90-day mortality and infection-related readmission in patients who received combination beta-lactam and fluoroquinolone therapy (OR, 4.2; 95% CI, 1.1–15.7; P = .03) [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

A Turtle Disaster: Salmonella enteritidis Cardiovascular Implantable Electronic Device Infection

Brenneman

Keil

Advani

et al. 2022

Open Forum Infectious Diseases

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Clinical outcomes of combination versus monotherapy for gram negative non-HACEK infective endocarditis

Cited by 14 publications

References 12 publications

Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis

Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis

Infective Endocarditis due to Non-HACEK Gram-Negative Bacilli: Clinical Characteristics and Risk Factors from a Prospective Multicenter Brazilian Cohort

A Turtle Disaster: Salmonella enteritidis Cardiovascular Implantable Electronic Device Infection

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