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Int J Antimicrob Agents. 2019 Jun 8. pii: S0924-8579(19)30147-5. doi: 10.1016/j.ijantimicag.2019.06.006. [Epub ahead of print]

High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis.

Author information

1
Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France.
2
USIC - SOS endocardites Fédération de cardiologie, CHU Henri Mondor, Créteil, France.
3
Urgences Néphrologiques et Transplantation Rénale, CHU Tenon, Paris, France.
4
Service d'Information Médicale, Hôpital de la Timone, Marseille, France.
5
Service de Cardiologie, Hôpital de la Timone, Marseille, France.
6
Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France.
7
Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France. Electronic address: didier.raoult@gmail.com.

Abstract

OBJECTIVE:

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.

METHODS:

This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.

RESULTS:

The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).

CONCLUSIONS:

The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.

KEYWORDS:

Clindamycin; Endocarditis; Mortality; Oral route; Staphylococcus aureus; Trimethoprim-sulfamethoxazole

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