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Multicenter Study
. 2023 Jan 13;76(2):281-290.
doi: 10.1093/cid/ciac777.

Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse

Pierre Danneels  1   2 , Jean-François Hamel  3 , Léa Picard  4   2 , Schéhérazade Rezig  5   2 , Pauline Martinet  5   2 , Aurélien Lorleac'h  6   2 , Jean-Philippe Talarmin  7   2 , Rodolphe Buzelé  8   2 , Thomas Guimard  9   2 , Gwenaël Le Moal  10   2 , Julia Brochard-Libois  11   2 , Aurélie Beaudron  12   2 , Julien Letheulle  13   2 , Cyrielle Codde  14   2 , Rachel Chenouard  15   2 , David Boutoille  16   2 , Adrien Lemaignen  17   2 , Louis Bernard  17   2 , Vincent Cattoir  18   19   20 , Vincent Dubée  1   2   21 ; EFEMER study group
Collaborators, Affiliations
Multicenter Study

Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse

Pierre Danneels et al. Clin Infect Dis. .

Abstract

Background: Enterococcus faecalis infective endocarditis (EFIE) is characterized by a higher frequency of relapses than other infective endocarditis. The role of the treatment on its occurrence remains poorly understood. The aim of this study was to investigate whether the antibiotic regimen could impact the risk of relapse in EFIE.

Materials: This was a multicenter retrospective study of patients diagnosed with definite EFIE between 2015 and 2019 in 14 French hospitals. The primary endpoint was the occurrence of relapses within the year following endocarditis diagnosis. As death was a competing risk for relapse, Fine and Gray models were used for studying risk factors and impact of treatment.

Results: Of the 279 patients included, 83 (29.7%) received the amoxicillin-gentamicin (A-G) combination, 114 (40.9%) amoxicillin-ceftriaxone (A-C), 63 (22.6%) A-G and A-C (A-G/A-C) sequentially, 9 (3.2%) amoxicillin (A), and 10 received other treatments. One-year-relapse rate was 9.3% (26 patients). Relapse occurred after a median delay of 107 days from EFIE diagnosis; 6 occurred after 6 months, and 6 were diagnosed by blood cultures in asymptomatic patients. In multivariate analysis, surgery during treatment was a protective factor against one-year relapse and death.The cumulative incidence of relapse 1 year after endocarditis was 46.2% for patients treated with amoxicillin, 13.4% with A-G, 14.7% with A-C, and 4.3% with A-G/A-C (P≥.05 in multivariate analysis).

Conclusions: Relapses after treatment of EFIE are frequent, frequently asymptomatic, and may occur more than 6 months after the initial episode.

Keywords: e. faecalis; amoxicillin; drug therapy combination; endocarditis; relapse.

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Figures

Figure 1.
Figure 1.
Valve culture result according to the time between the start of antibiotics and surgery.
Figure 2.
Figure 2.
Cumulative incidence of relapse and survival probability according to the treatment received. A: Cumulative incidence of relapse according to the treatment received in a Fine and Gray model (death considered as a competitive risk). B: Survival probability according to the treatment received in a Cox model. Comparison of different treatments with A-G combination considered as reference (A and B). Abbreviations: aHR, adjusted hazard ratio; aSHR, adjusted sub-distribution hazard ratio; CI, confidence interval.
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References

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