β-Lactam antibiotics versus Vancomycin for the Early Treatment of Enterococcal Bacteraemia: a Retrospective Cohort Study.
Int J Antimicrob Agents. 2019 Apr 04;:
Authors: Petersiel N, Bitterman R, Manaa A, Nashashibi L, Moskovich O, Geffen Y, Polak D, Braun E, Neuberger A, Paul M
BACKGROUND: The efficacy of vancomycin vs. ampicillin for Enterococcal infections is unknown. We aimed to compare their efficacy among patients with enterococcal bacteraemia.
METHODS: Retrospective cohort study including adults >16 years with enterococcal bacteraemia, treated with β-lactam antibiotics active against Enterococcus spp. or vancomycin. Treatment classification was based on the first antibiotic used for >4 days in the first 7 days from the time of blood culture collection. Subgroup analyses were performed including only patients with penicillin-susceptible enterococcal bacteremia and patients with monomicrobial penicillin-susceptible enterococcal bacteraemia. The dependent variable was 30-day all-cause mortality. We computed the propensity score (PS) for vancomycin treatment. Univariate and multivariate analyses adjusted to the PS were performed.
RESULTS: 516 patients with enterococcal bacteraemia were included. Mortality was similar for patients treated with β-lactams (123/315, 39%) and vancomycin (82/201, 40.8%). Independent factors significantly associated with mortality included health-care-associated or hospital-acquired infection, age, female sex, the Charlson Comorbidity index, dialysis, the SOFA score and low albumin. Adjusted to these and the PS, the odds ratio for death with vancomycin was 0.95 (95% confidence interval 0.56-1.59). Results were similar among all patients with penicillin-susceptible enterococcal bacteremia and when further limited to those with monomicrobial bacteraemia (n=237), adjusted OR 0.59 (95% CI 0.25-1.43).
CONCLUSION: We observed no difference in mortality following treatment with β-lactam or vancomycin among patients with enterococcal bacteraemia. Vancomycin is not recommended for the treatment of penicillin-susceptible enterococcal infections, but when needed it is not inferior to β-lactams and addition of a β-lactam is not necessary.
PMID: 30954636 [PubMed - as supplied by publisher]