Be careful about MICs to amoxicillin for patients with Streptococci-related infective endocarditis.
Adolescent
Adult
Aged
Aged, 80 and over
Amoxicillin
/ pharmacology
Anti-Bacterial Agents
/ pharmacology
Endocarditis
/ epidemiology
Female
France
/ epidemiology
Hospitals
Humans
Male
Microbial Sensitivity Tests
/ methods
Middle Aged
Retrospective Studies
Risk Factors
Streptococcal Infections
/ epidemiology
Streptococcus
/ classification
Survival Analysis
Young Adult
Infective endocarditis
Minimum inhibitory concentration
Streptococci
Journal
International journal of antimicrobial agents
ISSN: 1872-7913
Titre abrégé: Int J Antimicrob Agents
Pays: Netherlands
ID NLM: 9111860
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
04
01
2019
revised:
18
02
2019
accepted:
02
03
2019
pubmed:
10
3
2019
medline:
3
9
2019
entrez:
10
3
2019
Statut:
ppublish
Résumé
A variety of microorganisms can cause infective endocarditis (IE), with Staphylococci and Streptococci accounting for the majority of cases. Streptococci are a common cause of community-acquired IE but few studies have focused on this subgroup of endocarditis. A retrospective multicentre study was conducted between 2012 and 2017 in 12 hospital centres in France. Data were extracted from the local diagnosis-related group database and matched with microbiological results. After identification, the records were retrospectively analysed. A total of 414 patients with streptococcal endocarditis were included. The patients were predominantly male (72.8%) and the median age was 73.2 years (interquartile range [IQR] 61.3-80.9). The majority of patients (70.6%) had native valve endocarditis. Embolic complications were seen in 38.8% of patients. Viridans group Streptococci (VGS) and bovis-equinus group Streptococci (BGS) accounted for 52.4% and 34.5% of isolated strains, respectively. Minimum inhibitory concentrations (MICs) of amoxicillin were <0.125, 0.125-2 and >2 mg/L for 59.6%, 27% and 1% of isolates, respectively. In-hospital mortality for patients with Streptococci-related IE was 17.8%. In multivariate analysis, the only factor associated with in-hospital mortality was MIC for amoxicillin between 0.25 and 2 mg/L (P = 0.04; OR = 2.23 [95% confidence interval (CI) 1.03-4.88]) whereas performance of cardiac surgery for IE was a protective factor (P = 0.001, OR = 0.23 [95% CI 0.1-0.56]). IE remains a serious and deadly disease despite recent advances in diagnosis and treatment. Adaptation of antibiotic doses to MICs for amoxicillin and surgery may improve patient outcome.
Sections du résumé
BACKGROUND
BACKGROUND
A variety of microorganisms can cause infective endocarditis (IE), with Staphylococci and Streptococci accounting for the majority of cases. Streptococci are a common cause of community-acquired IE but few studies have focused on this subgroup of endocarditis.
METHODS
METHODS
A retrospective multicentre study was conducted between 2012 and 2017 in 12 hospital centres in France. Data were extracted from the local diagnosis-related group database and matched with microbiological results. After identification, the records were retrospectively analysed.
RESULTS
RESULTS
A total of 414 patients with streptococcal endocarditis were included. The patients were predominantly male (72.8%) and the median age was 73.2 years (interquartile range [IQR] 61.3-80.9). The majority of patients (70.6%) had native valve endocarditis. Embolic complications were seen in 38.8% of patients. Viridans group Streptococci (VGS) and bovis-equinus group Streptococci (BGS) accounted for 52.4% and 34.5% of isolated strains, respectively. Minimum inhibitory concentrations (MICs) of amoxicillin were <0.125, 0.125-2 and >2 mg/L for 59.6%, 27% and 1% of isolates, respectively. In-hospital mortality for patients with Streptococci-related IE was 17.8%. In multivariate analysis, the only factor associated with in-hospital mortality was MIC for amoxicillin between 0.25 and 2 mg/L (P = 0.04; OR = 2.23 [95% confidence interval (CI) 1.03-4.88]) whereas performance of cardiac surgery for IE was a protective factor (P = 0.001, OR = 0.23 [95% CI 0.1-0.56]).
CONCLUSIONS
CONCLUSIONS
IE remains a serious and deadly disease despite recent advances in diagnosis and treatment. Adaptation of antibiotic doses to MICs for amoxicillin and surgery may improve patient outcome.
Identifiants
pubmed: 30851401
pii: S0924-8579(19)30054-8
doi: 10.1016/j.ijantimicag.2019.03.002
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Amoxicillin
804826J2HU
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
850-854Investigateurs
V Cattoir
(V)
S Corvec
(S)
D Boutoille
(D)
G Péan de Ponfilly
(GP)
S Reissier
(S)
Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.