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17 April 2007 | Volume 146 Issue 8 | Pages 574-579
Background: High-level aminoglycoside resistance (HLAR) that precludes bactericidal synergism with penicillins or glycopeptides and nephrotoxicity related to aminoglycoside treatment are major problems in treating Enterococcus faecalis endocarditis.
Objective: To evaluate the efficacy and safety of ampicillin plus ceftriaxone for treating endocarditis due to E. faecalis with and without HLAR.
Design: Observational, open-label, nonrandomized, multicenter clinical trial.
Setting: 13 centers in Spain.
Patients: 21 patients with HLAR E. faecalis endocarditis and 22 patients with non-HLAR E. faecalis endocarditis. All were at risk for nephrotoxicity related to aminoglycoside use.
Intervention: 6-week course of intravenous ampicillin, 2 g every 4 hours, plus intravenous ceftriaxone, 2 g every 12 hours.
Measurements: Clinical and microbiological outcomes.
Results: The clinical cure rate at 3 months was 67.4% (29 of 43 patients) among all episodes. During treatment, 28.6% of patients with HLAR E. faecalis endocarditis and 18.2% of patients with non-HLAR E. faecalis endocarditis died of infection-related causes. The rate of clinical and microbiological cure in patients who completed the protocol was 100% in the HLAR E. faecalis endocarditis group. No episodes of breakthrough bacteremia occurred, although there were 2 relapses in the non-HLAR E. faecalis endocarditis group. Treatment was withdrawn in 1 case because of fever and skin rash.
Limitations: The study had a small sample and was observational.
Conclusion: 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.
Editors' Notes
Context
Contribution
Caution
Implication
—The Editors
Author and Article Information
From the Hospital Universitari Vall d'Hebron, Institut d'Investigacions Biomediques August Pi i Sunyer, Hospital de Bellvitge, Mutua de Terrassa, and Hospital Germans Tries i Pujol, Barcelona, Spain; Hospital Gregorio Marañón, Hospital Universitario de La Princesa, Hospital Doce de Octubre, and Hospital Ramón y Cajal, Madrid, Spain; Hospital de Cruces, Barakaldo, Spain; Hospital Virgen del Rocío, Seville, Spain; Hospital Reina Sofía, Córdoba, Spain; Hospital Juan Canalejo, La Coruña, Spain; and Universidad de La Rioja, Logroño, Spain.
Note: Presented in part at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Illinois, 16–19 December 2001 (abstract 1342).
Acknowledgment: The authors thank Celine Cavallo for Englishlanguage assistance.
Grant Support: Dr. Len received a research grant from Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008), and Dr. Miró received a research grant from Institut d'Investigacions Biomediques August Pi i Sunyer.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Joan Gavaldà, MD, Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain; e-mail, jgavalda{at}ir.vhebron.net.
Current Author Addresses: Drs. Gavaldà, Len, Tornos, Planes, Falcó, Almirante, and Pahissa: Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Drs. Miró and Marco: Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Calle Villarroel, 170, 08036 Barcelona, Spain.
Dr. Muñoz: Hospital Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain.
Dr. Montejo: Hospital de Cruces, Plaza de Cruces, s/n, 48903 Cruces/Barakaldo, Spain.
Dr. Alarcón: Hospital Virgen del Rocío, Avenida Manuel Siurot, s/n, 41013 Sevilla, Spain.
Dr. de la Torre-Cisneros: Hospital Reina Sofía, Menéndez Pidal, s/n, 14004 Córdoba, Spain.
Dr. Peña: Hospital de Bellvitge, Feixa Llarga, s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain.
Dr. Martínez-Lacasa: Hospital Mutua de Terrassa, Plaça Dr. Robert, 5, 08221 Terrassa, Barcelona, Spain.
Dr. Sarria: Hospital Universitario de La Princesa, Diego de León, 62, 28006 Madrid, Spain.
Dr. Bou: Hospital Juan Canalejo, Lugar Jubias de Arriba, La Coruña, Spain.
Dr. Aguado: Hospital Doce de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
Dr. Navas: Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9, 1, 28034 Madrid, Spain.
Dr. Romeu: Hospital Germans Tries i Pujol, Carretera de Canyet s/n, 08916 Badalona, Barcelona, Spain.
Dr. Torres: Universidad de La Rioja, Avenida de La Paz, 93, 26006 Logroño, Spain.
Author Contributions: Conception and design: J. Gavaldà, O. Len.
Analysis and interpretation of the data: J. Gavaldà, O. Len.
Drafting of the article: J. Gavaldà, O. Len.
Critical revision of the article for important intellectual content: J. Gavaldà, O. Len, V. Falcó, B. Almirante, A. Pahissa.
Final approval of the article: J. Gavaldà, O. Len, J.M. Miró, P. Muñoz, M. Montejo, A. Alarcón, J. de la Torre-Cisneros, C. Peña, X. Martínez-Lacasa, C. Sarria, G. Bou, J.M. Aguado, E. Navas, J. Romeu, F. Marco, C. Torres, P. Tornos, A. Planes, V. Falcó, B. Almirante, A. Pahissa.
Provision of study materials or patients: J. Gavaldà, O. Len, J.M. Miró, P. Muñoz, M. Montejo, A. Alarcón, J. de la Torre-Cisneros, C. Peña, X. Martínez-Lacasa, C. Sarria, G. Bou, J.M. Aguado, E. Navas, J. Romeu, F. Marco, C. Torres, P. Tornos, A. Planes, V. Falcó, B. Almirante.
Collection and assembly of data: J. Gavaldà, O. Len. ARTICLE
Brief Communication: Treatment of Enterococcus faecalis Endocarditis with Ampicillin plus Ceftriaxone
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