Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci
- PMID: 37345869
- DOI: 10.1093/cid/ciad375
Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci
Abstract
Background: Evidence supporting combination treatment with a beta-lactam plus an aminoglycoside (C-BA) for endocarditis caused by viridans and gallolyticus group streptococci (VGS-GGS) with intermediate susceptibility to penicillin (PENI-I) is lacking. We assessed the clinical characteristics and outcomes of PEN-I VGS-GGS endocarditis and compared the effectiveness and safety of C-BA with third-generation cephalosporin monotherapy.
Methods: Retrospective analysis of prospectively collected data of a cohort of definite endocarditis caused by penicillin-susceptible and PENI-I VGS-GGS (penicillin minimum inhibitory concentration ranging from 0.25 to 2 mg/L) between 2008 and 2018 in 40 Spanish hospitals. We compared cases treated with monotherapy or with C-BA and performed multivariable analyses of risk factors for in-hospital and 1-year mortality.
Results: A total of 914 consecutive cases of definite endocarditis caused by VGS-GGS with complete or intermediate susceptibility to penicillin were included. A total of 688 (75.3%) were susceptible to penicillin and 226 (24.7%) were PENI-I. Monotherapy was used in 415 (45.4%) cases (cephalosporin in 331 cases) and 499 (54.6%) cases received C-BA. In-hospital mortality was 11.9%, and 190 (20.9%) patients developed acute kidney injury. Heart failure (odds ratio [OR]: 6.06; 95% confidence interval [CI]: 1.37-26.87; P = .018), central nervous system emboli (OR: 9.83; 95% CI: 2.17-44.49; P = .003) and intracardiac abscess (OR: 13.47; 95% CI: 2.24-81.08; P = .004) were independently associated with in-hospital mortality among PEN-I VGS-GGS cases, while monotherapy was not (OR: 1.01; 95% CI: .26-3.96; P = .982).
Conclusions: Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.
Keywords: aminoglycoside; cephalosporin; infective endocarditis; intermediate susceptibility to penicillin; viridans group streptococci.
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Conflict of interest statement
Potential conflicts of interest . N. F.-H. reports payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events to their institution from Pfizer and support for attending meetings and/or travel from Shionogi. L. E.-V. reports a grant (Juan Rodes JR20/00020, 2021–2022) from the Instituto de Salud Carlos III, Madrid, Spain, and support for attending meetings and/or travel from MSD, Pfizer, and AstraZeneca. P. M. reports consulting fees for Advisory Board participation from Pfizer, Mundipharma, Shionogi, and Gilead; payment or honoraria as a speaker from Pfizer, Gilead, and Shionogi; payment for expert testimony from Mundipharma, Gilead; support for attending meetings and/or travel from Pfizer; and participation on a Data and Safety Monitoring Board or Advisory Board for Pfizer, Mudipharma, Shionogi, and Gilead. M. O. reports payment from Pfizer for a presentation about ceftolozane/tazobactam. M. A. G. reports payment for expert testimony (virtual workshop, 29 March 2023) and support for attending the National Infectious Congress (SEIMC) from Angelini Pharma. A. P. reports payment or honoraria for presentation and support for attending meetings and/or travel from Pfizer, MSD, and Angelini Pharma. G. C. reports honoraria for lectures (CARE XII; Paris, 29–30 November 2019) from Gilead Sciences Europe and support for attending national and international scientific congresses from Angelini Pharma Spain. J. C. reports payment for lectures from Gilead and payment for educational events from MSD. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
