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Brief Communication: Treatment of Enterococcus faecalis Endocarditis with Ampicillin plus Ceftriaxone
- Joan Gavaldà, MD;
- Oscar Len, MD;
- José M. Miró, MD;
- Patricia Muñoz, MD;
- Miguel Montejo, MD;
- Aristides Alarcón, MD;
- Julián de la Torre-Cisneros, MD;
- Carmen Peña, MD;
- Xavier Martínez-Lacasa, MD;
- Cristina Sarria, MD;
- Germán Bou, MD;
- José M. Aguado, MD;
- Enrique Navas, MD;
- Joan Romeu, MD;
- Francesc Marco, MD;
- Carmen Torres, MD;
- Pilar Tornos, MD;
- Ana Planes, MD;
- Vicenç Falcó, MD;
- Benito Almirante, MD; and
- Albert Pahissa, MD
- 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.
Abstract
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.
Article and Author Information
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Note: Presented in part at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Illinois, 16–19 December 2001 (abstract 1342).
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Acknowledgment: The authors thank Celine Cavallo for Englishlanguage assistance.
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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.
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Potential Financial Conflicts of Interest: None disclosed.
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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.
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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.
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Drs. Miró and Marco: Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Calle Villarroel, 170, 08036 Barcelona, Spain.
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Dr. Muñoz: Hospital Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain.
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Dr. Montejo: Hospital de Cruces, Plaza de Cruces, s/n, 48903 Cruces/Barakaldo, Spain.
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Dr. Alarcón: Hospital Virgen del Rocío, Avenida Manuel Siurot, s/n, 41013 Sevilla, Spain.
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Dr. de la Torre-Cisneros: Hospital Reina Sofía, Menéndez Pidal, s/n, 14004 Córdoba, Spain.
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Dr. Peña: Hospital de Bellvitge, Feixa Llarga, s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain.
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Dr. Martínez-Lacasa: Hospital Mutua de Terrassa, Plaça Dr. Robert, 5, 08221 Terrassa, Barcelona, Spain.
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Dr. Sarria: Hospital Universitario de La Princesa, Diego de León, 62, 28006 Madrid, Spain.
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Dr. Bou: Hospital Juan Canalejo, Lugar Jubias de Arriba, La Coruña, Spain.
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Dr. Aguado: Hospital Doce de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
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Dr. Navas: Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9, 1, 28034 Madrid, Spain.
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Dr. Romeu: Hospital Germans Tries i Pujol, Carretera de Canyet s/n, 08916 Badalona, Barcelona, Spain.
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Dr. Torres: Universidad de La Rioja, Avenida de La Paz, 93, 26006 Logroño, Spain.
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Author Contributions: Conception and design: J. Gavaldà, O. Len.
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Analysis and interpretation of the data: J. Gavaldà, O. Len.
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Drafting of the article: J. Gavaldà, O. Len.
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Critical revision of the article for important intellectual content: J. Gavaldà, O. Len, V. Falcó, B. Almirante, A. Pahissa.
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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.
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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.
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Collection and assembly of data: J. Gavaldà, O. Len.
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