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1.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(36): e17044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490396

RESUMO

RATIONALE: A single atrium is a rare congenital heart disease (CHD) involving zero atrial septal traces and preserved intact ventricular septum and atrioventricular valves, requiring careful surgical intervention. However, developing to Eisenmenger syndrome (ES) makes the surgery complicated. Based on bidirectional cardiac shunting, vegetation easily develops in case of bacterial infection. PATIENT CONCERN AND DIAGNOSES: We reported a 35-year-old woman with a single atrium, patent ductus arteriosus, pulmonary hypertension, and ES who developed infective endocarditis on her left ventricular outflow tract and complicated cerebral abscess and who underwent challenged medical treatment. INTERVENTION: Infection was successfully controlled after 4-time change in antibiotics over 4 months. However, surgery is complicated for her. OUTCOMES: The patient presented a relatively good outcome during follow-up for >6 months. LESSONS: This case report suggests that patients with complex CHD should accept surgery therapy earlier before developing ES. It is imperative to avoid invasive interventions to prevent infectious endocarditis.


Assuntos
Abscesso Encefálico/complicações , Permeabilidade do Canal Arterial/complicações , Complexo de Eisenmenger/complicações , Endocardite/complicações , Átrios do Coração/anormalidades , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Feminino , Humanos
3.
Epidemiol Mikrobiol Imunol ; 68(2): 104-108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398984

RESUMO

The Bartonella genus comprises more than 20 species of Gram-negative rods which are difficult to culture. These are facultative intracellular bacteria. Humans are reservoir hosts for B. quintana and B. bacilliformis or accidental hosts for other species. Bartonella is a cause of zoonosis. Bartonella infection can be completely asymptomatic or can be linked to various conditions. Our experience with Bartonella endocarditis from 2012-2017 is presented. The most effective diagnostic method for Bartonella endocarditis is PCR detection of DNA of the pathogen from excised valve tissue. The European Society of Cardiology (ESC) in the guidelines from 2015 recommends the combination doxycycline gentamycin for the treatment of Bartonella endocarditis.


Assuntos
Infecções por Bartonella , Endocardite , Animais , Bartonella , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Gentamicinas/uso terapêutico , Humanos , Zoonoses/diagnóstico , Zoonoses/tratamento farmacológico
4.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444523

RESUMO

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Assuntos
Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micoses/tratamento farmacológico , Adulto , Comorbidade , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Incidência , Micoses/diagnóstico , Micoses/epidemiologia
7.
Int Heart J ; 60(4): 983-985, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257331

RESUMO

Infective endocarditis (IE) is a lethal complication inpatients with congenital heart disease. We report a case of percutaneous implanted pulmonary valve IE in a 49-year-old female. She underwent a previous surgery for tetralogy of Fallot with transannular patching of the right ventricular outflow tractat the age of 18 years. Echocardiography showed chronic moderate to severe pulmonary regurgitation with right heart enlargement. She underwent transcatheter pulmonary valve implantation with a 26 mm Venus-P valve (Venus Medtech, Shanghai, China) in order to release pulmonary insufficiency. Two months after implantation, she presented with recurrent chills and febrile for one week, and percutaneous implanted pulmonary valve IE was diagnosed. According to the antibiotic susceptibility test, she was given penicillin and gentamycin. At 12 months follow-up, TTE showed vegetation completely disappeared and the valve functioned normally. The patient recovered uneventfully without any complications like recurrent IE.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
8.
BMC Infect Dis ; 19(1): 511, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182045

RESUMO

BACKGROUND: Infective endocarditis caused by Actinomyces spp. is extremely rare. However, cases by new species of Actinomyces have been increasingly reported due to advances in laboratory techniques, and many of these species do not cause classic presentations of actinomycosis. Actinomyces neuii is reported to have a tendency to cause endovascular infection. The course of infective endocarditis caused by Actinomyces spp. is usually indolent. CASE PRESENTATION: A 61-year-old man with history of infective endocarditis, end stage renal disease, and monoclonal gammopathy was admitted for an abrupt fever, confusion, dysarthria, and facial droop after hemodialysis. Echocardiogram showed vegetations on both the aortic and mitral valves. Two sets of blood culture grew A. neuii. Brain MRI showed multiple bilateral cerebral infarcts consistent with septic emboli. The patient recovered after valvular surgery and prolonged intravenous and oral antibiotic therapy. CONCLUSIONS: This case illustrates an unusually acute presentation of A. neuii infective endocarditis. As with other Gram-positive bacilli, Actinomyces spp. isolates are often regarded as a result of contamination. One should keep it in mind as a cause of infective endocarditis in vulnerable patient populations.


Assuntos
Actinomyces/isolamento & purificação , Actinomicose/diagnóstico , Endocardite/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/microbiologia , Doença Aguda , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade
9.
BMC Infect Dis ; 19(1): 438, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109283

RESUMO

BACKGROUND: Gram-positive organisms are a leading cause of infection in cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive cardiovascular infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. METHODS: ICU patients who received either DAP or VAN, prior to or after cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. RESULTS: Seventy two patients, treated for infective endocarditis, cardiovascular foreign body infection, or surgical site infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39-15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). CONCLUSIONS: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for cardiovascular procedure-related infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.


Assuntos
Lesão Renal Aguda/etiologia , Daptomicina/efeitos adversos , Vancomicina/efeitos adversos , Lesão Renal Aguda/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Doenças Cardiovasculares/cirurgia , Estado Terminal , Daptomicina/uso terapêutico , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Endocardite/etiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Vancomicina/uso terapêutico
10.
BMJ Case Rep ; 12(5)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31076496

RESUMO

An 18-year-old woman presented to our institution with fever, bilateral flank pain, headache and photophobia. She had a previous atrial septal defect (ASD) closure device inserted at the age of 9 years. Blood cultures on admission were positive for Corynebacterium diphtheriae, and transoesophageal echocardiogram (TOE) revealed an echodensity associated with the ASD closure device, most consistent with a vegetation. She was treated for infective endocarditis with 6 weeks of intravenous benzylpenicillin, and follow-up TOE showed resolution of the echodensity. To our knowledge, no cases of C. diphtheriaeendocarditis of an ASD closure device have previously been reported.


Assuntos
Antibacterianos/administração & dosagem , Corynebacterium diphtheriae/isolamento & purificação , Endocardite/diagnóstico , Comunicação Interatrial/cirurgia , Penicilina G/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Dispositivo para Oclusão Septal/microbiologia , Adolescente , Ecocardiografia Transesofagiana , Endocardite/tratamento farmacológico , Endocardite/fisiopatologia , Feminino , Febre/microbiologia , Dor no Flanco/microbiologia , Humanos , Infusões Intravenosas , Fotofobia/microbiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Dispositivo para Oclusão Septal/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
15.
BMJ Case Rep ; 12(3)2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30872338

RESUMO

Infective endocarditis (IE)-related glomerulonephritis (GN) typically resolves with the treatment of IE. A 59-year-old woman with a baseline creatinine of 0.7 mg/dL presented with rash on her legs, night sweats and weight loss for 3 weeks. Further evaluation revealed IE. Her blood cultures grew gamma-haemolytic streptococcus, which subsequently cleared on appropriate antibiotic therapy. Her creatinine, however, progressively worsened requiring haemodialysis. Kidney biopsy showed immune complex-mediated necrotising and crescentic GN. She was started on plasmapheresis (PE) and high-dose steroids with rapid taper, with subsequent improvement in her creatinine to 0.8 mg/dL. She subsequently had aortic valve replacement and ventricular septal defect closure. She did not improve as expected with antibiotic therapy but turned around dramatically with steroids and PE. Our case supports the possible beneficial role of PE and steroids in IE-related crescentic GN that worsens despite appropriate antibiotic therapy, although the risks of immunosuppression and aggravating endocarditis need to be considered.


Assuntos
Corticosteroides/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Glomerulonefrite/patologia , Plasmaferese/métodos , Lesão Renal Aguda/terapia , Corticosteroides/administração & dosagem , Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Glomerulonefrite/complicações , Glomerulonefrite/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
16.
PET Clin ; 14(2): 251-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826023

RESUMO

The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.


Assuntos
Endocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Antibacterianos/uso terapêutico , Eletrodos Implantados/efeitos adversos , Endocardite/tratamento farmacológico , Reações Falso-Negativas , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Coração Auxiliar/efeitos adversos , Humanos , Interpretação de Imagem Assistida por Computador , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Compostos Radiofarmacêuticos
17.
Nat Commun ; 10(1): 1149, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30850614

RESUMO

Treatment failure in biofilm-associated bacterial infections is an important healthcare issue. In vitro studies and mouse models suggest that bacteria enter a slow-growing/non-growing state that results in transient tolerance to antibiotics in the absence of a specific resistance mechanism. However, little clinical confirmation of antibiotic tolerant bacteria in patients exists. In this study we investigate a Staphylococcus epidermidis pacemaker-associated endocarditis, in a patient who developed a break-through bacteremia despite taking antibiotics to which the S. epidermidis isolate is fully susceptible in vitro. Characterization of the clinical S. epidermidis isolates reveals in-host evolution over the 16-week infection period, resulting in increased antibiotic tolerance of the entire population due to a prolonged lag time until growth resumption and a reduced growth rate. Furthermore, we observe adaptation towards an increased biofilm formation capacity and genetic diversification of the S. epidermidis isolates within the patient.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Resistência a Múltiplos Medicamentos/genética , Endocardite/microbiologia , Interações Hospedeiro-Patógeno/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/genética , Adulto , Bacteriemia/tratamento farmacológico , Bacteriemia/patologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Tolerância a Medicamentos/genética , Endocardite/tratamento farmacológico , Endocardite/patologia , Evolução Molecular , Fluoroquinolonas/farmacologia , Glicopeptídeos/farmacologia , Humanos , Mutação INDEL , Masculino , Testes de Sensibilidade Microbiana , Marca-Passo Artificial/microbiologia , Peptídeos Cíclicos/farmacologia , Filogenia , Polimorfismo de Nucleotídeo Único , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/crescimento & desenvolvimento , Staphylococcus epidermidis/isolamento & purificação , beta-Lactamas/farmacologia
19.
J Am Coll Cardiol ; 73(5): 559-570, 2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30732709

RESUMO

BACKGROUND: Rising rates of hospitalization for infective endocarditis (IE) have been increasingly tied to rising injection drug use (IDU) associated with the opioid epidemic. OBJECTIVES: This study analyzed recent trends in IDU-IE hospitalization and characterized outcomes and readmissions for IDU-IE patients. METHODS: The authors evaluated the National Readmissions Database (NRD) for IE cases between January 2010 and September 2015. Patients were stratified by IDU status and surgical versus medical management. Primary outcome was 30-day readmission and cause, with secondary outcomes including mortality, length of stay (LOS), adjusted costs, and 180-day readmission. The Kruskal-Wallis and chi-square tests were used to analyze baseline differences by IDU status. Multivariable regressions were used to analyze mortality, readmissions, LOS, and adjusted costs. RESULTS: The survey-weighted sample contained 96,344 (77.8%) non-IDU-IE and 27,432 (22.2%) IDU-IE cases. IDU-IE increased from 15.3% to 29.1% of IE cases between 2010 and 2015 (p < 0.001). At index hospitalization, IDU-IE was associated with reduced mortality (6.8% vs. 9.6%; p < 0.001) but not 30-day readmission (23.8% vs. 22.9%; p = 0.077) relative to non-IDU-IE. Medically managed IDU-IE patients had higher LOS (ß = 1.36 days; 95% confidence interval [CI]: 0.71 to 2.01), reduced costs (ß = -$4,427; 95% CI: -$7,093 to -$1,761), and increased readmission for endocarditis (18.1% vs. 5.6%; p < 0.001), septicemia (14.0% vs. 7.3%; p < 0.001), and drug abuse (4.3% vs. 0.7%; p < 0.001) compared with medically managed non-IDU-IE. Surgically managed IDU-IE patients had increased LOS (ß = 4.26 days; 95% CI: 2.73 to 5.80) and readmission for septicemia (15.6% vs. 5.2%; p < 0.001) and drug abuse (7.3% vs. 0.9%; p < 0.001) compared with non-IDU-IE. CONCLUSIONS: The incidence of IDU-IE continues to rise nationally. Given the increased readmission for endocarditis, septicemia, and drug abuse, IDU-IE presents a serious challenge to current management of IE.


Assuntos
Analgésicos Opioides , Endocardite , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Hospitalização , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa , Adolescente , Adulto , Endocardite/tratamento farmacológico , Endocardite/etiologia , Endocardite/mortalidade , Endocardite/cirurgia , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estados Unidos/epidemiologia
20.
Infection ; 47(3): 463-469, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30809761

RESUMO

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.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite/tratamento farmacológico , Enterococcus faecalis/efeitos dos fármacos , Teicoplanina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Endocardite/microbiologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prevenção Secundária
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