Brief communication: Treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone

  1. Gavaldà, J. 1212
  2. Len, O. 12
  3. Miró, J.M. 1
  4. Muñoz, P. 6
  5. Montejo, M. 3
  6. Alarcón, A. 13
  7. De La Torre-Cisneros, J. 10
  8. Peña, Carmen. 2
  9. Martínez-Lacasa, X. 8
  10. Sarria, C. 11
  11. Bou, G. 7
  12. Mateo Aguado, José María . 4
  13. Navas, E. 9
  14. Romeu, J. 5
  15. Marco, F. 1
  16. Torres, C. 14
  17. Tornos, P. 12
  18. Planes, A. 12
  19. Falcó, V. 12
  20. Almirante, B. 12
  21. Pahissa, A. 12
  1. 1 Institut d'Investigacions Biomèdiques August Pi i Sunyer
    info

    Institut d'Investigacions Biomèdiques August Pi i Sunyer

    Barcelona, España

    ROR https://ror.org/054vayn55

  2. 2 Hospital Universitari de Bellvitge
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    Hospital Universitari de Bellvitge

    l'Hospitalet de Llobregat, España

    ROR https://ror.org/00epner96

  3. 3 Hospital de Cruces
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    Hospital de Cruces

    Barakaldo, España

    ROR https://ror.org/03nzegx43

  4. 4 Hospital Universitario 12 de Octubre
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    Hospital Universitario 12 de Octubre

    Madrid, España

    ROR https://ror.org/00qyh5r35

  5. 5 Hospital Universitari Germans Trias i Pujol
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    Hospital Universitari Germans Trias i Pujol

    Barcelona, España

    ROR https://ror.org/04wxdxa47

  6. 6 Hospital General Universitario Gregorio Marañón
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    Hospital General Universitario Gregorio Marañón

    Madrid, España

    ROR https://ror.org/0111es613

  7. 7 Hospital Juan Canalejo, Lugar Jubias de Arriba, La Coruña, Spain
  8. 8 Mutua de Terrassa
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    Mutua de Terrassa

    Terrassa, España

    ROR https://ror.org/011335j04

  9. 9 Hospital Ramón y Cajal
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    Hospital Ramón y Cajal

    Madrid, España

    ROR https://ror.org/050eq1942

  10. 10 Hospital Universitario Reina Sofia
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    Hospital Universitario Reina Sofia

    Córdoba, España

    ROR https://ror.org/02vtd2q19

  11. 11 Hospital Universitario de la Princesa
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    Hospital Universitario de la Princesa

    Madrid, España

    ROR https://ror.org/03cg5md32

  12. 12 Hospital Vall d'Hebron
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    Hospital Vall d'Hebron

    Barcelona, España

    ROR https://ror.org/03ba28x55

  13. 13 Hospital Universitario Virgen del Rocío
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    Hospital Universitario Virgen del Rocío

    Sevilla, España

    ROR https://ror.org/04vfhnm78

  14. 14 Universidad de La Rioja
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    Universidad de La Rioja

    Logroño, España

    ROR https://ror.org/0553yr311

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Revista:
Annals of Internal Medicine

ISSN: 0003-4819

Año de publicación: 2007

Volumen: 146

Número: 8

Páginas: 574-579

Tipo: Artículo

DOI: 10.7326/0003-4819-146-8-200704170-00008 PMID: 17438316 SCOPUS: 2-s2.0-34247578807 GOOGLE SCHOLAR

Otras publicaciones en: Annals of Internal Medicine

Resumen

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. © 2007 American College of Physicians.