Abstract
The frequency of infective endocarditis (IE) has increased 3 times over the past 30 years. The incidence of IE morbidity is recorded in all countries of the world and in the Russian Federation more than 40 people per 1 million population get sick. One of the most frequent causative agents of infective endocarditis is Enterococcus faecalis (E. faecalis), which takes the third place in the structure of the frequency of IE pathogens. Enterococcal IE remains a disease with high mortality, despite the emergence of new groups of antibacterial drugs. This review includes the results of studies of the efficacy and safety of various antimicrobial regimens of IE caused by E. faecalis. The analysis of data from foreign and native studies of antimicrobial treatment in patients with infective endocarditis, accompanied by enterococcal bacteremia is presented in the review. The search for literature performed by using medical databases: MEDLINE, EMBASE, eLIBRARY. The current review included studies of the efficacy and safety of antimicrobial treatment. The main antibiotic therapy regimens of IE caused by E. faecalis include 2 beta-lactam antibiotics or a combination of ampicillin and gentamicin, according to the results of 5 found studies. Found antimicrobial regimens significantly did not affect mortality. Data from international registries testify to the efficacy and safety of daptomycin monotherapy for enterococcal endocarditis. Linezolid and daptomycin are the main drugs of treating infective endocarditis caused by vancomycin-resistant enterococci. Native studies report of a high level of resistance of enterococcal strains to beta-lactam antibacterial drugs. The duration of fever, the frequency of surgical heart valves interventions, the duration of bacteremia are not fully represented in each of the studies, and it is difficult to evaluate these factors. Ampicillin+ceftriaxone and ampicillin+gentamicin are the main antimicrobial treatment regimens of enterococcal endocarditis. Efficacy of these regimens is not significantly different. Treatment of IE should be carried out taking into the epidemiological situation and the strain resistance.
Highlights
За последние 30 лет частота инфекционного эндокардита (ИЭ) возросла в 3 раза
One of the most frequent causative agents of infective endocarditis is Enterococcus faecalis (E. faecalis), which takes the third place in the structure of the frequency of IE pathogens
The analysis of data from foreign and native studies of antimicrobial treatment in patients with infective endocarditis, accompanied by enterococcal bacteremia is presented in the review
Summary
Более 90% энтерококковых инфекций вызваны Enterococcus faecalis Энтерококки являются причиной инфекций кровотока менее чем в 10% всех случаев. В структуре энтерококковых эндокардитов E. faecalis как этиологический фактор составляет около 97% случаев, а на втором месте по частоте выделения стоит E. Что более свойственно для E. faecalis, является особой проблемой для повышения эффективности и безопасности антибактериальной терапии [7]. Характеризуется более неблагоприятным прогнозом, чем вызванный E. faecalis, что обусловлено высокой частотой резистентных штаммов (до 80%). Летальность больных ИЭ, вызванным ванкомицин-резистентными энтерококками (vancomycin-resistant enterococci, VRE), достигает 20-46%, что в 2,5 раза выше, чем у пациентов с ИЭ, вызванным ванкомицин-чувствительным энтерококком. Это указывает на необходимость поиска новых методов повышения эффективности и безопасности антибактериальной терапии (АБТ) энтерококкового ИЭ [8,9]. Целью настоящего обзора являлся анализ данных зарубежных и отечественных исследований по выбору антибактериальной терапии у больных с ИЭ, сопровождающимся энтерококковой бактериемией, и определить перспективы дальнейшего изучения данного направления
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