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
Calderón-Parra, J. (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Grillo, Sara (Institut de Recerca Sant Pau)
Muñoz, P. (Hospital General Universitario Gregorio Marañón)
Machado-Vilchez, M. (Hospital General Universitario Gregorio Marañón)
Delgado-Montero, A. (Hospital General Universitario Gregorio Marañón)
De Alarcón González, Arístides (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Poyato-Borrego, M. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Goenaga-Sánchez, M.A. (Hospital de Donostia (Sant Sebastià, País Basc))
Fariñas-Alvarez, M.C. (Institut de Salut Carlos III)
Miró, J.M. (Institut de Salut Carlos III)
López-Cortés, L.E. (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Rodríguez-García, R. (Hospital Universitario Central de Asturias)
Oteo, J.A. (Hospital Universitario San Pedro)
Martínez-Ramos, A. (Universidad Autónoma de Madrid)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Combination therapy ; Infective endocarditis ; Mortality ; Prognosis ; Staphylococcus aureus
Publicat a:	Journal of Infection, Vol. 89 Núm. 6 (december 2024) , p. 106352, ISSN 1532-2742

DOI: 10.1016/j.jinf.2024.106352
PMID: 39561880

8 p, 1.1 MB

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