Efficacy and safety of antistaphylococcal penicillin or cephazolin-based combinations versus monotherapy for methicillin-susceptible Staphylococcus aureus infective endocarditis: A propensity score analysis of nationwide prospective cohort - 06/12/24
, Sara Grillo c, Patricia Muñoz d, e, Marina Machado-Vilchez d, e, Antonia Delgado-Montero f, g, Arístides De Alarcón-González h, i, j, Manuel Poyato-Borrego h, i, j, MA Goenaga-Sánchez k, M. Carmen Fariñas-Alvarez l, m, José M. Miró n, o, Luis Eduardo López-Cortés p, q, Raquel Rodríguez-García r, José A. Oteo s, t, Antonio Martínez-Ramos a, b, uon behalf of the Spanish Collaboration on Endocarditis (GAMES)
Summary |
Objectives |
We aimed to evaluate the usefulness of antistaphylococcal penicillin (ASP) or cephazolin-based combinations versus monotherapy in patients with native-valve infective endocarditis (IE) caused by methicillin-susceptible Staphylococcus aureus (MSSA).
Methods |
Post-hoc analysis of a multicentre prospective cohort. We include patients from 2008 to 2022 with definite native-valve, left-side IE due to MSSA treated primarily with ASP/cephazolin. Patients were categorized according to whether they initially received monotherapy or combination therapy for more than 72 h. A propensity score-matched cohort was planned.
Results |
Out of 420 included cases, 94 (22.4%) received monotherapy and 326 (77.6%) combination. Median combination duration was 14 days (interquartile range 10–20).
Sixty-eight combination cases were matched with 68 monotherapy controls. Baseline characteristics were well balanced. There were no differences in in-hospital or one-year mortality between groups (OR 0.85, 95%CI 0.33–2.18 and HR 0.68, 95%CI 0.35–1.31, respectively). Endocarditis relapses and persistent bacteraemia rates were similar (0% vs 1.5%, p = 1.000; and 19.1% vs 13.2%, p = 0.352, respectively). Drug-related adverse events were more frequent in the combination group (15.0% vs 1.1%, p < 0.001).
Conclusions |
Antibiotic combinations for patients with native valve left-sided MSSA endocarditis did not improve patient’s outcomes. Drug-related adverse events were more frequent in combination patients.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Highlights |
• | Propensity score analysis of a prospective multicenter endocarditis cohort. |
• | Antistaphylococcal penicillin or cephazolin alone versus in combination therapy. |
• | Patients with native valve infective endocarditis due to Staphylococcus aureus. |
• | Combination treatment did not result in better clinical outcomes. |
• | Combination antibiotics were associated with more frequent adverse effects. |
Keywords : Infective endocarditis, Staphylococcus aureus, Combination therapy, Prognosis, Mortality
Plan
Vol 89 - N° 6
Article 106352- décembre 2024 Retour au numéro
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