Infective endocarditis caused by Streptococcus agalactiae: time for beta-hemolytic streptococci to follow treatment recommendations for S. aureus?

Sendi, Parham

doi:10.1007/s10096-018-03446-2

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…For the management of IE caused by b-haemolytic streptococci, we recommend not adding AG to antibiotic regimens for the following reasons: (a) b-haemolytic streptococci are usually fully susceptible to b-lactams, (b) they do not exhibit tolerance to penicillin and (c) no robust clinical data support the use of AG in this setting [49].…”

Section: Ag-free Regimen For All Ie?mentioning

confidence: 99%

Aminoglycosides for infective endocarditis: time to say goodbye?

Lebeaux

Fernández-Hidalgo

Pilmis

et al. 2020

Clinical Microbiology and Infection

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Background: Based on experimental studies showing synergism with b-lactams and glycopeptides, aminoglycosides have long been considered essential in the treatment of infective endocarditis (IE). However, their use is associated with a high risk of renal failure, especially in elderly patients. Aims: The aim of this narrative review was to summarize the evidence to support reducing or even avoiding the use of aminoglycosides for the treatment of IE. We also analysed data supporting the use of aminoglycosides in specific subgroup of IE patients. Sources: PubMed database was searched up to July 2019 to identify relevant studies. Contents: Recent European Guidelines reduced the use of aminoglycosides in IE, no longer recommended in Staphylococcus aureus native-valve IE, and shortened to 2 weeks for IE related to Enterococcus faecalis and streptococci with penicillin MIC >0.125 mg/mL. In addition, an alternative regimen without aminoglycosides (ampicillin or amoxicillin plus ceftriaxone) is proposed for E. faecalis. Observational studies suggested that gentamicin would not be necessary in the case of staphylococcal prosthetic valve IE as long as rifampicin is maintained. Recent clinical studies showed that for streptococcal IE, gentamicin could be restricted to isolates with penicillin MIC >0.5 mg/mL. For the empirical and definitive treatment of E. faecalis IE, amoxicillin or ampicillin plus ceftriaxone may be considered, irrespective of high-level of aminoglycoside resistance. Implications: In a scenario of progressive increase in the age and frailty of IE patients, the use of aminoglycosides can be reduced or avoided in~90% cases. This should result in reduced incidence of renal failure, an important prognostic factor in IE.

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Section: Ag-free Regimen For All Ie?mentioning

confidence: 99%

Aminoglycosides for infective endocarditis: time to say goodbye?

Lebeaux

Fernández-Hidalgo

Pilmis

et al. 2020

Clinical Microbiology and Infection

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“…IE caused by non-viridans streptococci and in particular beta-haemolytic streptococci (BHS), have been associated with in-hospital mortality rates between 13–20% in comparable studies [ 6 , 27 , 28 ]. The clinical presentation of IE caused by BHS resemble that of IE caused by S. aureus, with more often an initial dysregulated immune response to infection and need for more aggressive therapy and surgery than IE caused by viridans group streptococci [ 28 , 29 ]. Interestingly, Streptococcus dysgalacticae accounted for 51% of IE caused by non-viridans streptococci in our patient cohort.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and microbial trends of infective endocarditis in western Norway: a 7-year prospective observational study

Jordal,

Kommedal,

Haaverstad

et al. 2024

BMC Infect Dis

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Background In this prospective, observational study, we aimed to investigate epidemiologic and microbial trends of infective endocarditis in western Norway. Methods Clinical and microbiological characteristics of 497 cases of infective endocarditis from 2016 through 2022 were investigated. Categorical data were analysed using Chi-squared tests. Survival data were analysed using multiple Cox regression and reported using hazard ratios. Results The mean age was 67 years, and 74% were men. The annual incidence rates varied from 10.4 to 14.1 per 100,000 inhabitants per year. Infective endocarditis on native valves was observed in 257 (52%) of the cases, whereas infective endocarditis on prosthetic valves and/or cardiac implantable electronic devices was observed in 240 (48%) of the cases: infection on surgically implanted bioprostheses was observed in 124 (25%) of the patients, infection on transcatheter aortic valve implantation was observed in 47 (10%) patients, and infection on mechanical valves was observed in 34 (7%) cases. Infection related to cardiac implantable electronic devices was observed in a total of 50 (10%) cases. Staphylococcus aureus and viridans streptococci were the most common microbial causes, and isolated in 145 (29%) and 130 (26%) of the cases, respectively. Enterococcal endocarditis showed a rising trend during the study period and constituted 90 (18%) of our total cases of infective endocarditis, and 67%, 47%, and 26% of the cases associated with prosthetic material, transcatheter aortic valve implantation and cardiac implantable electronic devices, respectively. There was no significant difference in 90-day mortality rates between the native valve endocarditis group (12%) and the group with infective endocarditis on prosthetic valves or cardiac implants (14%), p = 0.522. In a model with gender, age, people who inject drugs, microbiology and type of valve affected, only advanced age was significantly associated with fatal outcome within 90 days. Conclusions The incidence of infective endocarditis, and particularly enterococcal endocarditis, increased during the study period. Enterococci appeared to have a particular affinity for prosthetic cardiac material. Advanced age was the only independent risk factor for death within 90 days.

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“…European and American guidelines for IE, have recommended the adjunction of gentamicin for two weeks in BHS IE [5,6]. Some authors recently proposed to abandon this recommendation in native valve IE given the lack of evidence [21].…”

Section: Discussionmentioning

confidence: 99%

Virulence of beta-hemolytic streptococci in infective endocarditis

et al. 2019

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Background Streptococci involved in infective endocarditis (IE) primarily comprise alpha-or non-hemolytic streptococci (ANHS). Moreover, beta-hemolytic streptococci (BHS) can be involved, and guidelines recommend the addition of gentamicin for the first 2 weeks of treatment and the consideration of early surgery in such cases. This study compared the morbidity and mortality associated with IE depending on the microorganisms involved (BHS, ANHS, staphylococci, and enterococci). Methods We conducted a retrospective observational study between 2012 and 2017 in a single hospital in France. The endpoints were overall in-hospital mortality, 1-year mortality and the occurrence of complications. ResultsWe analyzed 316 episodes of definite IE including 150 (38%), 96 (25%), 46 (12%), and 24 cases (6%) of staphylococcal, ANHS, enterococcal, and BHS IE, respectively. In-hospital mortality was significantly higher in the staphylococcal (n = 40; 26.7%) and BHS groups (n = 6; 25.0%) than in the ANHS (n = 9; 9.4%) and enterococcal groups (n = 5; 10.9%) (all p < 0.01). The rates of septic shock and cerebral emboli were also higher in the BHS group than in the ANHS group [n = 7 (29.2%) vs. n = 3 (3.1%), p < 0.001; n = 7 (29.2%) vs. n = 12 (12.5%); p = 0.05, respectively]. Conclusion This study confirmed that BHS IE has a more severe prognosis than ANHS IE. The virulence of BHS may be similar to that of staphylococci, justifying increased monitoring of these patients and more 'aggressive' treatments such as early surgery.

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Infective endocarditis caused by Streptococcus agalactiae: time for beta-hemolytic streptococci to follow treatment recommendations for S. aureus?

Cited by 4 publications

References 29 publications

Aminoglycosides for infective endocarditis: time to say goodbye?

Aminoglycosides for infective endocarditis: time to say goodbye?

Epidemiological and microbial trends of infective endocarditis in western Norway: a 7-year prospective observational study

Virulence of beta-hemolytic streptococci in infective endocarditis

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