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2023-06-22

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/208469

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

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https://doi.org/10.1093/cid/ciad375

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Background: 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. Methods: 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. Results: 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). Conclusions: Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.

Matèries

Infeccions per estreptococs, Cefalosporines, Medicaments antibacterians, Penicil·lina, Endocarditis

Matèries (anglès)

Streptococcal infections, Cephalosporines, Antibacterial agents, Penicillin, Endocarditis

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Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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ESCRIHUELA VIDAL, Francesc, BERBEL, Dàmaris, FERNÁNDEZ HIDALGO, Nuria, ESCOLÀ VERGÉ, Laura, MUÑOZ, Patricia, OLMEDO SAMPERIO, María, GOENAGA SÁNCHEZ, Miguel ángel, GOIKOETXEA AGIRRE, Ane josune, FARIÑAS, María carmen, ALARCÓN, Aristides de, MIRÓ MEDA, José m. (josé maría), OJEDA BURGOS, Guillermo, PLATA, Antonio, CUERVO REQUENA, Guillermo, CARRATALÀ, Jordi, GAMES Investigators.. Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci. _Clinical Infectious Diseases_. 2023. Vol. 77, núm. 9, pàgs. 1273-1281. [consulta: 31 de gener de 2026]. ISSN: 1058-4838. [Disponible a: https://hdl.handle.net/2445/208469]

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