Thomas De Nadaï1, Mathilde François2, Agnès Sommet3,4, Damien Dubois5,6, David Metsu7,8, Marion Grare5,6, Bruno Marchou1, Pierre Delobel1,9, Guillaume Martin-Blondel10,11. 1. Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse CEDEX 9, France. 2. Department of Internal Medicine, Lyon University Hospital, Lyon, France. 3. Department of Medical Pharmacology, Toulouse University Hospital, Toulouse, France. 4. INSERM Unité 1027, Toulouse, France. 5. Department of Bacteriology, Toulouse University Hospital, Toulouse, France. 6. IRSD, Toulouse University, INSERM, INRA, ENVT, UPS, Toulouse, France. 7. Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France. 8. INTHERES UMR1436 INRA-ENVT, Toulouse, France. 9. INSERM UMR1043 - CNRS UMR5282, Centre de Physiopathologie Toulouse Purpan, Toulouse, France. 10. Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse CEDEX 9, France. martin-blondel.g@chu-toulouse.fr. 11. INSERM UMR1043 - CNRS UMR5282, Centre de Physiopathologie Toulouse Purpan, Toulouse, France. martin-blondel.g@chu-toulouse.fr.
Abstract
PURPOSE: Teicoplanin is often used in Enterococcus faecalis infective endocarditis as a relay in case of penicillin side effects, or in outpatients. We assessed the efficacy of teicoplanin used as continuation therapy after initial standard treatment of E. faecalis endocarditis. METHODS: All adult patients consecutively diagnosed between 1997 and 2016 for E. faecalis endocarditis were retrospectively reviewed. Patients who received standard therapy (ST) were compared to those switched to teicoplanin to complete the treatment (teicoplanin therapy, TT). RESULTS: Seventy-one patients were enrolled: 34 in the ST group and 37 in the TT group. Amoxicillin was replaced by teicoplanin after a median duration of 18 days (IQ25 - 75 12-21). Teicoplanin (5.8 ± 2.3 mg/kg) was administered for a median duration of 29 days (IQ25 - 75 25-34). Gentamicin therapy was similar. Overall duration of antimicrobial therapy was 42 days (IQ25 - 75 35-43) in the ST group, and 46 days (IQ25 - 75 43-49) in the TT group (p = 0.001). Global and endocarditis-related mortality rates were 22/34 (65%) and 13/34 (38%) in the ST group, and 14/37 (38%) and 3/37 (8%) in the TT group (p ≤ 0.05). Relapses occurred in 2/26 patients who survived the treatment phase in the ST group (8%) and in 3/37 in the TT group (8%, p = 0.68). All relapses in the TT group occurred in patients presenting prosthetic valve endocarditis. Finally, 20 patients were cured in the ST group (59%), and 33 patients in the TT group (89%, p = 0.003). CONCLUSIONS: In E. faecalis endocarditis, the switch to teicoplanin in selected patients following an initial phase of standard treatment represents an alternative, particularly for outpatient therapy. Caution should be exercised in cases of prosthetic valve endocarditis.
PURPOSE:Teicoplanin is often used in Enterococcus faecalisinfective endocarditis as a relay in case of penicillin side effects, or in outpatients. We assessed the efficacy of teicoplanin used as continuation therapy after initial standard treatment of E. faecalisendocarditis. METHODS: All adult patients consecutively diagnosed between 1997 and 2016 for E. faecalisendocarditis were retrospectively reviewed. Patients who received standard therapy (ST) were compared to those switched to teicoplanin to complete the treatment (teicoplanin therapy, TT). RESULTS: Seventy-one patients were enrolled: 34 in the ST group and 37 in the TT group. Amoxicillin was replaced by teicoplanin after a median duration of 18 days (IQ25 - 75 12-21). Teicoplanin (5.8 ± 2.3 mg/kg) was administered for a median duration of 29 days (IQ25 - 75 25-34). Gentamicin therapy was similar. Overall duration of antimicrobial therapy was 42 days (IQ25 - 75 35-43) in the ST group, and 46 days (IQ25 - 75 43-49) in the TT group (p = 0.001). Global and endocarditis-related mortality rates were 22/34 (65%) and 13/34 (38%) in the ST group, and 14/37 (38%) and 3/37 (8%) in the TT group (p ≤ 0.05). Relapses occurred in 2/26 patients who survived the treatment phase in the ST group (8%) and in 3/37 in the TT group (8%, p = 0.68). All relapses in the TT group occurred in patients presenting prosthetic valve endocarditis. Finally, 20 patients were cured in the ST group (59%), and 33 patients in the TT group (89%, p = 0.003). CONCLUSIONS: In E. faecalisendocarditis, the switch to teicoplanin in selected patients following an initial phase of standard treatment represents an alternative, particularly for outpatient therapy. Caution should be exercised in cases of prosthetic valve endocarditis.
Authors: Laura Herrera-Hidalgo; Jose Manuel Lomas-Cabezas; Luis Eduardo López-Cortés; Rafael Luque-Márquez; Luis Fernando López-Cortés; Francisco J Martínez-Marcos; Javier de la Torre-Lima; Antonio Plata-Ciézar; Carmen Hidalgo-Tenorio; Maria Victoria García-López; David Vinuesa; Alicia Gutiérrez-Valencia; Maria Victoria Gil-Navarro; Arístides De Alarcón Journal: J Clin Med Date: 2021-12-21 Impact factor: 4.241
Authors: Laura Herrera-Hidalgo; Arístides de Alarcón; Luis E López-Cortes; Rafael Luque-Márquez; Luis F López-Cortes; Alicia Gutiérrez-Valencia; María V Gil-Navarro Journal: Antibiotics (Basel) Date: 2020-09-30