ANTISTAPHYLOCOCCAL β-LACTAMS VS. VANCOMYCIN FOR THE TREATMENT OF INFECTIVE ENDOCARDITIS DUE TO METHICILLIN-SUSCEPTIBLE COAGULASE-NEGATIVE STAPHYLOCOCCI. A PROSPECTIVE COHORT STUDY FROM THE INTERNATIONAL COLLABORATION ON ENDOCARDITIS (ICE).
Antimicrob Agents Chemother. 2016 Aug 15;
Authors: Carugati M, Petti CA, Arnold C, Miro J, Pericàs J, Garcia de la Maria C, Kanafani Z, Durante-Mangoni E, Baddley J, Wray D, Klein JL, Delahaye F, Fernandez-Hidalgo N, Hannan MM, Murdoch D, Bayer A, Chu VH
Abstract
BACKGROUND: The phenotypic expression of methicillin resistance among coagulase-negative staphylococci (CoNS) is heterogeneous regardless of presence of the mecA gene. The potential discordance between phenotypic and genotypic results has led to the use of vancomycin for the treatment of CoNS infective endocarditis (IE) regardless of methicillin MIC values. In this study, we assessed the outcome of methicillin-susceptible CoNS IE among patients treated with anti-staphylococcal β-lactams (ASB) vs. vancomycin (VAN).
METHODS: Multicenter cohort study based on the International Collaboration on Endocarditis (ICE) Prospective Cohort Study (PCS) and the ICE-Plus databases. ICE-PCS contains prospective data on 5,568 patients with IE between 2000 and 2006, while ICE-Plus contains prospective data on 2,019 patients with IE between 2008 and 2012. Primary endpoint was in-hospital mortality. Secondary endpoints were 6-month mortality and survival time.
RESULTS: Of the 7,587 patients in the two databases, there were 280 patients with methicillin-susceptible CoNS IE. Detailed treatment and outcome data were available in 180 patients. Eighty-eight patients received ASB, while 36 were treated with VAN. In-hospital mortality (19.3% vs.11.1%; p=0.27), 6-month mortality (31.6% vs. 25.9%; p=0.58), and survival time after discharge (p=0.26) did not significantly differ in the two cohorts. Cox regression analysis did not show any significant association between ASB use and the survival time (HR 1.7; p=0.22); this result was not affected by adjusting for confounders.
CONCLUSIONS: This study provides no evidence for a difference in outcome with the use of VAN vs. ASB for methicillin-susceptible CoNS IE.
PMID: 27527083 [PubMed - as supplied by publisher]