Comparing Treatment Outcomes of Ampicillin-Sulbactam, Other β-Lactams, and Vancomycin in Blood Culture-Negative Infective Endocarditis.

Se Ju Lee,Young Goo Song,Jin Young Ahn,Eun Hwa Lee,Jun Yong Choi,Seung Hyun Lee,Jung Ho Kim,Jin Nam Kim,Su Jin Jeong,Nam Su Ku,Hi Jae Lee,Ki Hyun Lee,Yae Jee Baek,Joon Sup Yeom

doi:10.3390/antibiotics10121476

Se Ju Lee, Young Goo Song + Show 12 more

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https://doi.org/10.3390/antibiotics10121476

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Abstract

Selection of proper antibiotics for blood culture-negative infective endocarditis (BCNIE) is difficult due to limited data on antibiotic regimens for BCNIE in existing literature. The aim of this study was to compare ampicillin-sulbactam, other β-lactams antibiotics, and vancomycin among patients with BCNIE to determine the proper antibiotic regimens. This retrospective study included adult patients with BCNIE admitted to Severance Hospital from November 2005 to August 2017. Patients were classified into three groups as, treated with ampicillin-sulbactam, other β-lactams, and vancomycin. The primary outcome was 1-year all-cause mortality. A total of 74 cases with BCNIE were enrolled in this study. There were no statistically significant differences in clinical characteristics between the three groups. One-year mortality did not significantly differ between the study groups either. Further, in-hospital mortality, 28-day mortality and overall mortality showed no difference. However, Cox-regression analysis showed nosocomial infective endocarditis as an independent risk factor and a protective effect of surgery on 1-year mortality. This study showed no clear difference in the outcomes of BCNIE as per the antibiotic therapy but suggested the beneficial effect of surgical treatment. With increasing global concern of antimicrobial resistance, it might be reasonable to select ampicillin-sulbactam-based antibiotic therapy while actively considering surgical treatment in BCNIE.

Highlights

Despite significant improvements in the management of infective endocarditis (IE), it is still associated with a high mortality rate [1]
We compared clinical outcomes among patients with blood culture-negative infective endocarditis (BCNIE) treated with ampicillinsulbactam, other β-lactam antibiotics, and vancomycin
The different antibiotic groups had no significant effect on the 1-year mortality of the patients with BCNIE

Summary

Introduction

Despite significant improvements in the management of infective endocarditis (IE), it is still associated with a high mortality rate [1]. For successful treatment of IE, administration of proper antibiotics to eradicate the implicating microorganisms is important [2]. Several guidelines have recommended antibiotic regimens and duration of therapy according to the causative pathogens [2,3,4]. Pathogen identification is essential for determining the treatment strategy of IE and not merely for the diagnosis. As per a previous study, blood culture-negative infective endocarditis (BCNIE) accounts for 31% of all cases of IE [5]. A negative result of microbial blood culture in IE may result from administration of antibiotics before performing blood culture, infection caused by fastidious bacteria or fungi, and/or inadequate microbiological techniques [6,7]

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