ro13-9904 and Endocarditis

Trueperella pyogenes (T. pyogenes) is a bacterium that colonizes the skin and mucosal surfaces of various domestic and wild animals. It rarely leads to infections in humans, with only a few descriptions available in the literature.. A 71-year-old Swiss farmer with a history of recurring basal cell carcinoma and metastasized pancreatic neuroendocrine tumor presented with signs of sepsis after a three-day history of general weakness, malaise and fever. Clinical and echocardiographic findings, as well as persistent bacteremia were consistent with mitral valve endocarditis caused by T. pyogenes. The patient's condition gradually improved under antibiotic treatment with piperacillin/tazobactam (empiric therapy of sepsis), and later penicillin G based on resistance testing. He was discharged after 13 days and continued outpatient antibiotic therapy with ceftriaxone, resulting in a total antibiotic treatment duration of six weeks. This is the first literature review of T. pyogenes endocarditis in humans. Among nine cases of T. pyogenes endocarditis, three patients had documented contact with farm animals and five had an underlying condition that compromised the immune system. While antibiotic resistance of T. pyogenes is an emerging concern, susceptibility to beta-lactam antibiotics seems to persist. The mortality of T. pyogenes endocarditis described in the literature was high, with 66% of patients not surviving the disease.. T. pyogenes is a rare causative organism of infectious endocarditis in humans and descriptions are mainly restricted to case reports. In our review of the literature, we found that both an impaired immune system and contact with farm animals might be risk factors. Growth of T. pyogenes in blood cultures is unlikely to be missed during routine analysis, as it shows marked beta-hemolysis on blood agar culture plates, which generally leads to further characterization of the bacteria. Susceptibility to penicillin, ceftriaxone, and macrolides seems to be retained and the reported mortality in the few patients with T. pyogenes endocarditis is high.

Topics: Aged; Animals; Animals, Domestic; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Endocarditis, Bacterial; Farmers; Humans; Sepsis; Switzerland

Current guidelines recommend either ampicillin plus ceftriaxone (AC) or amoxicillin/ampicillin plus gentamicin (AG) with an equivalent class IB recommendation in Enterococcus faecalis endocarditis. However, previous observational studies suggest that AC might be favourable in terms of adverse events.. To investigate whether AC is non-inferior to AG, and if it is associated with less adverse events.. In June 2021, a systematic literature search using the databases PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS was conducted by two independent reviewers. Studies were considered eligible if (P) patients included were ≥ 18 years of age and had IE with E. faecalis, (I) treatment with AC was compared to (C) treatment with AG and (O) outcomes on in-hospital mortality, nephrotoxicity and adverse events requiring drug withdrawal were reported. Odds ratios and 95% confidence intervals were calculated using random-effects models with the Mantel-Haenszel method, the Sidik-Jonkman estimator for τ. Treatment with AC was non-inferior to AG, as depicted by no significant differences in-hospital mortality, 3-month mortality, relapses or treatment failure. Furthermore, AC was associated with a lower prevalence of nephrotoxicity (OR 0.45 [0.26-0.77], p = 0.0182) and drug withdrawal due to adverse events (OR 0.11 [0.03-0.46], p = 0.0160) than AG.. Treatment with AC was non-inferior to treatment with AG, and it was associated with a reduced prevalence of nephrotoxicity and drug withdrawal due to adverse events. Thus, combination therapy with AC appears favourable over AG in patients with E. faecalis IE.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Heart Diseases; Humans; Renal Insufficiency

We report here an atypical case of acute sacroiliitis caused by

Topics: Animals; Ceftriaxone; Ciprofloxacin; Endocarditis; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Middle Aged; Sacroiliitis

Topics: Anti-Bacterial Agents; Canada; Ceftriaxone; Emigration and Immigration; Endocarditis; Female; Health Services Accessibility; Humans; Insurance, Health; Middle Aged

Infective endocarditis caused by Proteus mirabilis is rare and is fatal in most cases. A case of a 64-year-old man presenting with fever, dysuria, and murmur is reported. P mirabilis endocarditis was diagnosed based on clinical presentation, blood culture findings, and the presence of a large mitral valve vegetation seen on echocardiogram. The patient survived after long-term antibiotics and surgical replacement of the mitral valve. The clinical characteristics and complications from reported cases of P mirabilis endocarditis are reviewed.

Topics: Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Doxycycline; Echocardiography; Endocarditis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve; Proteus Infections; Proteus mirabilis

Neisseria elongata subsp. nitroreducens, an usual commensal of the nasopharynx, can cause serious infections, usually endocarditis. A case of Neisseria elongata endocarditis complicating mitral valve prolapse in a patient allergic to penicillin is reported. Cure was obtained with a combination of ceftriaxone and gentamicin, there being no requirement for surgery during the acute phase of the disease.

Topics: Adult; Ceftriaxone; Endocarditis; Gentamicins; Humans; Male; Neisseria

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Humans; Penicillins

Whipple's disease is known to cause multiple varied systemic symptoms, and is a well-documented cause of culture-negative endocarditis. Endocarditis secondary to Whipple disease, however, has rarely been known to present primarily as a cause of acute limb ischemia. We describe such a case here.. A previously healthy 40 year old man presented to the emergency department with acute-onset right arm paresthesias. On exam, he was found to be tachycardic with a VI/VI systolic ejection murmur. He was diagnosed with critical limb ischemia and severe aortic regurgitation, and echocardiography showed a large mass on his bicuspid aortic valve. Thrombectomy was performed urgently, with aortic valve repair the following day. As blood cultures and valvular tissue culture remained unrevealing, the patient remained on empiric vancomycin and ceftriaxone for culture-negative endocarditis. 16 s rRNA nucleic acid amplification testing (NAAT) of his formalin-fixed, paraffin-embedded valvular tissue detected T. whipplei, after which the patient was transitioned to ceftriaxone and trimethoprim-sulfamethoxazole for a year of therapy. He continues to do clinically well.. We report an unusual presentation of Whipple endocarditis as an acute upper limb ischemia, absent other classic symptoms of Whipple's disease, and with diagnosis made by 16 s rRNA NAAT of valvular tissue in the setting of culture-negative endocarditis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Endocarditis, Bacterial; Humans; Ischemia; Male; Rare Diseases; Tropheryma; Whipple Disease

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Catheters; Ceftriaxone; Echocardiography; Endocarditis; Humans; Male; Microbial Sensitivity Tests; Micrococcaceae; Treatment Outcome

We report a rare case of an infective endocarditis by Aerococcus spp in a bioprosthetic aortic valve following a prostate biopsy, in an asymptomatic adult with no additional risk factor for prostate cancer, excepting for age. The diagnosis was based on the presence of vegetations on the bioprosthesis seen on the echocardiogram, positive blood cultures and fever, and a favorable clinical outcome following the treatment with ceftriaxone and gentamicin.

Topics: Aerococcus; Aged; Biopsy; Ceftriaxone; Echocardiography; Endocarditis; Female; Fever; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Prostate; RNA, Ribosomal, 16S; Treatment Outcome

Treatment regimens requiring multiple daily dosing for enterococcal endocarditis are challenging to deliver in the outpatient setting. Continuous-infusion benzylpenicillin via a 24 h elastomeric infusor, combined with either once-daily gentamicin or ceftriaxone, requires only one nursing encounter daily and is commonly used in New Zealand.. To assess the therapeutic success and adverse antibiotic effects of these regimens.. A retrospective observational case series from multiple hospitals of patients aged 15 years or over with enterococcal endocarditis diagnosed between July 2013 and June 2019 who received at least 14 days of outpatient continuous-infusion benzylpenicillin combined with either gentamicin or ceftriaxone for synergy.. Forty-three episodes of enterococcal endocarditis in 41 patients met inclusion criteria. The primary synergy antibiotic was gentamicin in 20 episodes and ceftriaxone in 23 episodes. For the 41 initial treatment courses, 31 (76%) patients were cured, 3 (7%) patients developed relapsed endocarditis during or following antibiotic treatment and 7 (17%) patients continued with long-term suppressive oral amoxicillin following IV antibiotic treatment. There was no difference in the relapse rate between the two groups (P = 0.59). Seven (35%) adverse antibiotic effects were documented in the gentamicin group and none in the ceftriaxone group (P < 0.01). Two deaths (5%) occurred within the 6 month follow-up period.. Outpatient treatment of enterococcal endocarditis with continuous-infusion benzylpenicillin combined with either once-daily gentamicin or ceftriaxone following a period of inpatient treatment is usually effective. A significantly higher rate of adverse effects was seen with gentamicin, favouring ceftriaxone as the initial synergy antibiotic.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Gentamicins; Humans; Outpatients; Penicillin G; Retrospective Studies

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Valve Stenosis; Ceftriaxone; Computed Tomography Angiography; Embolectomy; Embolism; Endocarditis; Fatal Outcome; Gentamicins; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Postoperative Complications; Streptococcus salivarius; Thrombosis; Transcatheter Aortic Valve Replacement; Ultrasonography, Doppler

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Prospective Studies; Time Factors

Many regional and remote hospitals (RRHs) do not have the specialist services that usually support antimicrobial stewardship (AMS) programmes in major city hospitals. It is not known if this is associated with higher rates of inappropriate antimicrobial prescribing. The aim of this study was to identify similarities and differences in antimicrobial prescribing patterns between major city hospitals and RRHs in Australia. The Australian Hospital National Antimicrobial Prescribing Survey (H-NAPS) datasets from 2014, 2015 and 2016 (totalling 47,876 antimicrobial prescriptions) were analysed. The antimicrobial prescribed, indications for use, documentation of indication, recording of a review date and assessment of the appropriateness of prescribing were evaluated. Overall, inappropriate prescribing of antimicrobials was higher in RRHs than in major city hospitals (24.0% vs. 22.1%; P<0.001). Compared with major city hospitals, inappropriate prescribing of ceftriaxone was higher in RRHs (33.9% vs. 27.6%; P<0.001), as was inappropriate prescribing for cellulitis (25.7% vs. 19.0%; P≤0.001). A higher rate of inappropriate prescribing was noted for some high-risk infections in RRHs compared with major city hospitals, including Gram-positive bacteraemia with sepsis (12.6% vs. 6.5%; P=0.004), empiric therapy for sepsis (26.0% vs. 12.0%; P<0.001) and endocarditis (8.2% vs. 2.7%; P=0.02). To the authors' knowledge, this is the largest study to date comparing antimicrobial prescribing of RRHs with major city hospitals. A key finding was that antimicrobial prescribing was more frequently inappropriate for some high-risk infections treated in RRHs. Targeted strategies that support appropriate antimicrobial prescribing in RRHs are required.

Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Australia; Bacteremia; Ceftriaxone; Cellulitis; Endocarditis; Hospitals, Rural; Hospitals, Urban; Humans; Inappropriate Prescribing; Practice Patterns, Physicians'; Sepsis

Enterococcus faecalis is the third most common causal agent of infective endocarditis. Currently, the treatment recommended is a combination of ampicillin (2 g/4 h) plus ceftriaxone (2 g/12 h), so patients must remain hospitalized for almost 6 weeks to receive the treatment. They are not generally included in outpatient parenteral antimicrobial therapy programs because 2 different electronic pumps are required to administer these 2 antibiotics. To enable the treatment of patients with E. faecalis IE at home, we designed a continuation combination regimen of ceftriaxone 4 g once daily in a short infusion plus ampicillin 2 g/4 h using a programmable pump.. We analyzed a cohort of patients attended in an outpatient parenteral antimicrobial therapy program that has been working since 2012 in 2 tertiary hospitals. We selected patients attended in this program for E. faecalis IE treated with a continuation regimen of ampicillin 12 g daily (2 g/4 h) and ceftriaxone 4 g every 24 hours between July 2012 and March 2017.. Of the 720 patients included in the outpatient parenteral antimicrobial therapy program, 42 had infective endocarditis, and 4 (9.52%) were treated using the combination regimen described above. All patients were men, and all had left-sided native-valve infective endocarditis. All 4 patients received ampicillin 2 g every 4 hours and ceftriaxone 2 g every 12 hours in hospital, for a median duration of 25 days (IQR 15-32). Thereafter, in the program, they received the following regimen: a 30-minute infusion of ceftriaxone 4 g in 250 mL of saline solution, followed by ampicillin 12 g daily in 500 mL of saline solution delivered by a pump programmed to administer 2 g every 4 hours. Patients received this treatment at home for a median of 22.5 days (IQR 13-32). All patients achieved clinical and microbiological cure with no recurrences or complications after a lengthy follow-up period (median 365 days, IQR 221-406). No drug-related adverse events or problems with the pump system were reported.. Use of ceftriaxone 4 g in a single dose yields a mean plasma concentration of 30 μg/mL. Ceftriaxone also has a high plasma protein binding capability, and once this binding is saturated, there is no reason to administer higher doses. Therefore, it seems reasonable to use a dose of 4 g of ceftriaxone once daily to have a synergist effect with ampicillin within the vegetation, and enable the treatment of patients with E. faecalis infective endocarditis at home. In conclusion, the administration of ampicillin (2 g/4 h) plus ceftriaxone (4 g/24 h) as a continuation regimen in an outpatient parenteral antimicrobial therapy program may be as effective and safe as the usual lengthy in-hospital regimen (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) in patients with E. faecalis infective endocarditis.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Synergism; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Outpatients

Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE.. This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates.. Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79%) of patients received A+G while 18 (21%) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17% vs. 17%, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [-0.3, 0.1] mg/dL, P≤.001).. A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Electronic Health Records; Endocarditis; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Recurrence; Retrospective Studies

We described a rare case of meningitis and infective endocarditis (IE) due to

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Humans; Meningitis; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis; Humans; Intracranial Embolism; Male; Middle Aged; Occipital Lobe; Parietal Lobe; Secondary Prevention; Skin Diseases; Streptococcal Infections; Streptococcus gordonii; Treatment Outcome

A 77-year-old man visited our hospital with unstable gait following 2 months of anorexia. Brain MRI showed multiple infarcts; cardiac echocardiography revealed mitral-valve vegetation; and blood culture revealed methicillin-resistant coagulase-negative staphylococci. The patient was diagnosed with infective endocarditis (IE). Subarachnoid hemorrhage (SAH) developed ten days after antibiotic treatment. Intracranial aneurysm was not found. We speculated that chronic inflammation of the cerebral arterial walls by bacteria of low virulence was associated with SAH complication. The vegetation disappeared following additional gentamicin administration and the patient recovered to walk.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Subarachnoid Hemorrhage; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Topics: Anti-Bacterial Agents; Arthritis; Ceftriaxone; Endocarditis; Endophthalmitis; Epididymitis; Humans; Male; Middle Aged; Myositis; Orchitis; Whipple Disease

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Dysarthria; Emergency Service, Hospital; Endocarditis; Humans; Hyperemia; Male; Pacemaker, Artificial; Staphylococcus aureus; Superior Vena Cava Syndrome; Thrombosis

The problem of prosthetic heart valve selection in fertile women with acquired heart defects remains crucial in modern cardiology. Mechanical heart valves require lifelong indirect anticoagulant therapy, which has significant fetal toxicity and is unacceptable for women planning pregnancy. Bioprosthetic heart valves are the best choice for fertile women; however, their durability is limited, and reoperations are required.. We describe the clinical case of a 21-year-old Russian woman with infectious endocarditis who underwent heart valve replacement with an epoxy-treated mitral valve prosthesis.. Epoxy-treated bioprosthetic heart valves can be used without long-term anticoagulant therapy because of their optimal hemodynamic functional parameters. Moreover, their high thromboresistance and resistance to infection improve patients' quality of life in their late postoperative period. We recommend these valves both in older persons and in young patients including women who are planning pregnancy.

Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Cesarean Section; Endocarditis; Female; Fertility; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Infectious; Pregnancy Outcome; Shock, Septic

Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve.

Topics: Aged; Animals; Anti-Bacterial Agents; Aortic Valve; Bioprosthesis; Ceftriaxone; Endocarditis; Fishes; Food Microbiology; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Lactococcus; Male; Raw Foods; Seafood

The first cases of infective endocarditis due to a new species of Bergeyella, Bergeyella cardium sp. nov., are reported. Two strains, 13-07(T) (= JCM 30115(T) = NCCP 15908(T)) and 13-16, were independently isolated from 2 patients in different hospitals in Korea. Initially, the isolates were identified as Brevundimonas spp.; however, their 16S rRNA gene sequences shared a similarity of 94.9% with Bergeyella zoohelcum, implying that they are a new species belonging to of the genus Bergeyella. The organisms might be susceptible to many commonly used antibiotics, including penicillin. The first case was successfully treated with ceftriaxone, and the second, with piperacillin/tazobactam plus amikacin.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Endocarditis; Flavobacteriaceae; Hospitals; Humans; Korea; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Sequence Data; Penicillanic Acid; Phylogeny; Piperacillin; Piperacillin, Tazobactam Drug Combination; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome

The aim of this study was to assess changes in antibiotic resistance, epidemiology and outcome among patients with Enterococcus faecalis infective endocarditis (EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our centre from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/day) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4-6 weeks. Increased rates of high-level aminoglycoside resistance (HLAR; gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997-2006 and 49% in 2007-2011; p 0.03). The use of A+C increased over time: 1997-2001, 4/18 (22%); 2002-2006, 5/16 (31%); 2007-2011, 30/35 (86%) (p <0.001). Renal failure developed in 65% of the A+G group and in 34% of the A+C group (p 0.014). Thirteen patients (43%) in the A+G group had to discontinue treatment, whereas only one patient (3%) treated with A+C had to discontinue treatment (p <0.001). Only development of heart failure and previous chronic renal failure were independently associated with 1-year mortality, while the individual antibiotic regimen (A+C vs. A+G) did not affect outcome (OR, 0.7; 95% CI, 0.2-2.2; p 0.549). Our study shows that the prevalence of HLAR EFIE has increased significantly in recent years and that alternative treatment with A+C is safer than A+G, with similar clinical outcomes, although the sample size is too small to draw firm conclusions. Randomized controlled studies are needed to confirm these results.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Prospective Studies; Renal Insufficiency; Spain; Survival Analysis; Treatment Outcome; Withholding Treatment

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Bicuspid Aortic Valve Disease; Ceftriaxone; Endocarditis; Heart Defects, Congenital; Heart Valve Diseases; Humans; Male; Streptococcal Infections; Streptococcus oralis; Treatment Outcome

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Aged; Amoxicillin; Antibodies, Bacterial; Antigens, Bacterial; Bacterial Typing Techniques; Ceftriaxone; Chromatography, Affinity; Cross Reactions; Delayed Diagnosis; Drug Resistance, Bacterial; Drug Substitution; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; False Positive Reactions; Gentamicins; Humans; Male; Meningitis, Bacterial; Species Specificity; Spinal Puncture; Streptococcus pneumoniae

The aim of this study was to compare the effectiveness of the ampicillin plus ceftriaxone (AC) and ampicillin plus gentamicin (AG) combinations for treating Enterococcus faecalis infective endocarditis (EFIE).. An observational, nonrandomized, comparative multicenter cohort study was conducted at 17 Spanish and 1 Italian hospitals. Consecutive adult patients diagnosed of EFIE were included. Outcome measurements were death during treatment and at 3 months of follow-up, adverse events requiring treatment withdrawal, treatment failure requiring a change of antimicrobials, and relapse.. A larger percentage of AC-treated patients (n = 159) had previous chronic renal failure than AG-treated patients (n = 87) (33% vs 16%, P = .004), and AC patients had a higher incidence of cancer (18% vs 7%, P = .015), transplantation (6% vs 0%, P = .040), and healthcare-acquired infection (59% vs 40%, P = .006). Between AC and AG-treated EFIE patients, there were no differences in mortality while on antimicrobial treatment (22% vs 21%, P = .81) or at 3-month follow-up (8% vs 7%, P = .72), in treatment failure requiring a change in antimicrobials (1% vs 2%, P = .54), or in relapses (3% vs 4%, P = .67). However, interruption of antibiotic treatment due to adverse events was much more frequent in AG-treated patients than in those receiving AC (25% vs 1%, P < .001), mainly due to new renal failure (≥25% increase in baseline creatinine concentration; 23% vs 0%, P < .001).. AC appears as effective as AG for treating EFIE patients and can be used with virtually no risk of renal failure and regardless of the high-level aminoglycoside resistance status of E. faecalis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Hospitals; Humans; Italy; Male; Middle Aged; Spain; Treatment Outcome; Young Adult

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Enterococci have recently been recognized as a causative organism of intractable infections, including severe sepsis and infective endocarditis, in immunocompromised patients. This study investigated the epidemiological, microbiological, and prognostic characteristics of high-level gentamicin-resistant (HLGR) enterococcal bacteremia, including severe cases of infective endocarditis, in Japan. A total of 155 enterococcal bacteremia episodes were identified between July 2007 and December 2009. HLGR strains accounted for 28% of all enterococcal strains: HLGR Enterococcus faecalis/Enterococcus faecium strains accounted for 32%/24%. The 30-day mortality rate was 31%. There was no significant difference in the 30-day mortality rates between HLGR and non-HLGR enterococcal bacteremia. There were two cases of HLGR enterococcal endocarditis, which were successfully treated with ampicillin plus ceftriaxone. We consider it important to examine the presence or absence of HLGR strains in all cases of intractable enterococcal infection, especially infective endocarditis.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Drug Resistance, Bacterial; Endocarditis; Enterococcus; Gentamicins; Humans; Sepsis

We present a case of endocarditis with embolic stroke and digital infarction due to the recently renamed Aggregatibacter aphrophilus. The isolation and identification of this organism can be problematic but was achieved in this case using both older phenotypic and newer genotypic methods. A benign tongue lesion is suggested as the likely portal of entry for this oropharyngeal organism. The patient made a good recovery with six weeks of intravenous ceftriaxone but will need cardiac valvular surgery at some point in the future.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebral Infarction; Endocarditis; Fingers; Haemophilus Infections; Haemophilus paraphrophilus; Humans; Infarction; Male; Middle Aged

Late prosthetic valve endocarditis is usually caused by streptococci, staphylococci, gram-negative bacilli and candida. The authors report the first case of prosthetic valve endocarditis caused by Gemella sanguinis. The patient's risk factors for the development of Gemella endocarditis were the persistent severe dental caries and the presence of prosthetic valves. The patient required surgical replacement of the infected valve but had a good outcome with preservation of cardiac and valvular function. Evaluation and treatment of the persistent dental infection before initial valvular surgery may have prevented secondary infection of the prosthetic valve.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Dental Caries; Drug Administration Schedule; Echocardiography; Endocarditis; Female; Gemella; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Transplantation, Homologous; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; DNA, Bacterial; Endocarditis; Female; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Infusions, Intravenous; Sequence Analysis, DNA; Treatment Outcome

A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Humans; Male; Mitral Valve; Salmonella typhi; Typhoid Fever; Ultrasonography; Young Adult

In 2004-2008, the epidemiological and clinical Infective Endocarditis Study Group (SEI) evaluated 852 cases of infective endocarditis. Staphylococcus aureus was the main involved pathogen (24.5%) and Enterococcus faecalis etiology was described in 11% of the cases. The aim of this study was to evaluate the in vitro activity of 12 antibiotics alone and in association against 27 strains of E. faecalis isolated from blood cultures of patients with infective endocarditis.. The results showed high in vitro activity of tigecycline, daptomycin and linezolid. A high synergistic effect was obtained with the association ceftriaxone-fosfomycin [fractional inhibitory concentration (FIC)(50) = 0.34, FIC(90) = 0.78]. Furthermore, ceftriaxone plus ampicillin presented additive results (FIC(50) = 0.66, FIC(90) = 1.00), and ceftriaxone plus fosfomycin and ceftriaxone plus ampicillin were significantly more active in vitro than each drug alone. The efficacy of ceftriaxone plus fosfomycin was confirmed by the association testing using the broth dilution technique.. Fosfomycin seems particularly significant and its association with ceftriaxone could be considered as a useful therapeutic option in medical treatment of E. faecalis infective endocarditis.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Synergism; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; Fosfomycin; Gram-Positive Bacterial Infections; Humans; Italy; Microbial Sensitivity Tests; Sheep

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Humans; Male; Paratyphoid Fever; Salmonella paratyphi A

Topics: Adolescent; Anesthetics, Local; Anti-Bacterial Agents; Aortic Valve Insufficiency; Aspirin; Bardet-Biedl Syndrome; Ceftriaxone; Endocarditis; Gentamicins; Humans; Male; Penicillins; Platelet Aggregation Inhibitors; Procaine; Rheumatic Heart Disease; Risk Factors

Cerebral hemorrhage occurs rarely in endocarditis caused by Actinobacillus actinomycetemcomitans. A 51-year-old man with a prosthetic mitral valve, who had been prophylactically treated (7 years) with warfarin, presented with intermittent fever. On admission, a Levine grade II/VI systolic cardiac murmur was detected. A transthoracic echocardiogram was negative for valve vegetation. Cefepime (1 g every 8 hours) was administered intravenously. On day 4, culturing of Gram-negative bacilli from blood and a transesophageal echocardiogram revealed a small oscillating filament attached to lateral mitral prosthetic ring on the atrial side. Ceftriaxone (2 g once daily) was started. Gait instability and left-side weakness developed abruptly 2 weeks later; brain magnetic resonance imaging revealed a hematoma over the right parietal-occipital lobe. Ceftriaxone was adjusted to 2 g every 12 hours. Actinobacillus actinomycetemcomitans was identified 3 weeks later. Recovery was achieved, with significant interval improvement and resolution of the cerebral lesions evident on CT.

Topics: Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Cerebral Hemorrhage; Endocarditis; Humans; Male; Middle Aged; Warfarin

Mycotic aneurysms on the branches of vertebro basilar artery are rare. A patient of infective endocarditis with mycotic aneurysm on the posterior cerebral artery is described. The aneurysm resolved with medical therapy. Controversies regarding the management of mycotic aneurysms are discussed.

Topics: Adult; Anti-Bacterial Agents; Basilar Artery; Ceftriaxone; Cephalosporins; Cerebral Angiography; Endocarditis; Gentamicins; Humans; Intracranial Aneurysm; Male; Vertebral Artery

Topics: Adult; Ceftriaxone; Cephalosporins; Clostridium Infections; Diagnosis, Differential; Echocardiography; Endocarditis; Enterobacteriaceae Infections; Escherichia; Heart Injuries; Humans; Male; Wounds, Gunshot

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Gentamicins; Home Care Services; Humans; Infusions, Intravenous; United States