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Escrihuela_JAC-PENR_revised_20240812.pdf (1.35 MB)

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2024-10-01

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/227973

Infective endocarditis caused by penicillin-resistant viridans group streptococci: a series of nine cases from a Spanish cohort

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https://doi.org/10.1093/jac/dkae345

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Background Infective endocarditis (IE) caused by viridans and gallolyticus group streptococci (VGS-GGS) resistant to penicillin (PEN-R; minimum inhibitory concentration >= 4 mg/L) is rare but poses therapeutic challenges.Objectives To describe the characteristics of patients with IE caused by PEN-R VGS-GGS, focusing on antimicrobial management.Methods Retrospective analysis of a prospective cohort of definite IE caused by PEN-R VGS-GGS between 2008 and 2023 in 40 Spanish hospitals. We describe clinical characteristics, management and outcome of the cases, and compare them to IE caused by VGS-GGS with susceptibility or susceptibility with increased exposure to penicillin (PEN-I).Results We identified nine cases of PEN-R VGS-GGS IE in a cohort of 1563 streptococcal IE (0.58%). All isolates belonged to S. mitis group. Three cases died during hospitalization and no relapse occurred at 3 months of follow-up. Compared to cases with susceptibility or PEN-I, PEN-R showed a higher rate of mitral location (78% versus 51%), surgical indication (67% versus 51%), and in-hospital mortality (33% versus 12%). Most cases (86%) showed resistance to third-generation cephalosporins. The preferred antibiotic regimen was beta-lactam-based: ceftriaxone plus gentamicin, penicillin plus gentamicin, ceftriaxone plus levofloxacin, and ceftaroline plus daptomycin. Two cases received a combination of vancomycin plus gentamicin. Levofloxacin was used in two cases in combination with ceftriaxone or daptomycin. All patients that received cardiac surgery were cured at the end of follow-up.Conclusions IE caused by PEN-R VGS-GGS was rare and only affected mitis group streptococci. Antibiotic combination including a beta-lactam seems to be effective in its management.

Matèries

Endocarditis, Infeccions per estreptococs, Antibiòtics betalactàmics

Matèries (anglès)

Endocarditis, Streptococcal infections, Beta lactam antibiotics

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Col·leccions

Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

ESCRIHUELA-VIDAL, Francesc, et al. Infective endocarditis caused by penicillin-resistant viridans group streptococci: a series of nine cases from a Spanish cohort. Journal of Antimicrobial Chemotherapy. 2024. Vol. 79, num. 12, pags. 3230-3235. ISSN 1460-2091. [consulted: 8 of August of 2026]. Available at: https://hdl.handle.net/2445/227973

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