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Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis.

Ramos-Martínez, Antonio; Muñoz Serrano, Alejandro; de Alarcón González, Arístides; Muñoz, Patricia; Fernández-Cruz, Ana; Valerio, Maricela; Fariñas, María Carmen; Gutiérrez-Cuadra, Manuel; Miró, José Ma; Ruiz-Morales, Josefa; Sousa-Regueiro, Dolores; Montejo, José Miguel; Gálvez-Acebal, Juan; HidalgoTenorio, Carmen; Domínguez, Fernando.
J Infect Chemother; 24(7): 555-562, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29628387

PURPOSE:

To analyze the influence of adding gentamicin to a regimen consisting of ß-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE).

METHODS:

From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on ß-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin.

RESULTS:

Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis.

CONCLUSIONS:

The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
Selo DaSilva