PDF(Pubmed)
Abstract：
UNASSIGNED: The role of suppressive antimicrobial therapy (SAT) in infective endocarditis (IE) management has yet to be defined. The objective of this study was to describe the use of SAT in an IE referral center and the patients\' outcomes.
UNASSIGNED: We conducted a retrospective observational study in a French IE referral center (Paris). All patients with IE who received SAT between 2016 and 2022 were included.
UNASSIGNED: Forty-two patients were included (36 male [86%]; median age [interquartile range {IQR}], 73 [61-82] years). The median Charlson Comorbidity Index score (IQR) was 3 (1-4). Forty patients (95%) had an intracardiac device. The most frequent microorganisms were Enterococcus faecalis (15/42, 36%) and Staphylococcus aureus (12/42, 29%). SAT indications were absence of surgery despite clinical indication (28/42, 67%), incomplete removal of prosthetic material (6/42, 14%), uncontrolled infection source (4/42, 10%), persistent abnormal uptake on nuclear imaging (1/42, 2%), or a combination of the previous indications (3/42, 7%). Antimicrobials were mainly doxycycline (19/42, 45%) and amoxicillin (19/42, 45%). The median follow-up time (IQR) was 398 (194-663) days. Five patients (12%) experienced drug adverse events. Five patients (12%) presented with a second IE episode during follow-up, including 2 reinfections (different bacterial species) and 3 possible relapses (same bacterial species). Fourteen patients (33%) in our cohort died during follow-up. Overall, the 1-year survival rate was 84.3% (73.5%-96.7%), and the 1-year survival rate without recurrence was 74.1% (61.4%-89.4%).
UNASSIGNED: SAT was mainly prescribed to patients with cardiac devices because of the absence of surgery despite clinical indication. Five (12%) breakthrough second IE episodes were reported. Prospective comparative studies are required to guide this empirical practice.
UNASSIGNED: We conducted a retrospective observational study in a French IE referral center (Paris). All patients with IE who received SAT between 2016 and 2022 were included.
UNASSIGNED: Forty-two patients were included (36 male [86%]; median age [interquartile range {IQR}], 73 [61-82] years). The median Charlson Comorbidity Index score (IQR) was 3 (1-4). Forty patients (95%) had an intracardiac device. The most frequent microorganisms were Enterococcus faecalis (15/42, 36%) and Staphylococcus aureus (12/42, 29%). SAT indications were absence of surgery despite clinical indication (28/42, 67%), incomplete removal of prosthetic material (6/42, 14%), uncontrolled infection source (4/42, 10%), persistent abnormal uptake on nuclear imaging (1/42, 2%), or a combination of the previous indications (3/42, 7%). Antimicrobials were mainly doxycycline (19/42, 45%) and amoxicillin (19/42, 45%). The median follow-up time (IQR) was 398 (194-663) days. Five patients (12%) experienced drug adverse events. Five patients (12%) presented with a second IE episode during follow-up, including 2 reinfections (different bacterial species) and 3 possible relapses (same bacterial species). Fourteen patients (33%) in our cohort died during follow-up. Overall, the 1-year survival rate was 84.3% (73.5%-96.7%), and the 1-year survival rate without recurrence was 74.1% (61.4%-89.4%).
UNASSIGNED: SAT was mainly prescribed to patients with cardiac devices because of the absence of surgery despite clinical indication. Five (12%) breakthrough second IE episodes were reported. Prospective comparative studies are required to guide this empirical practice.
摘要：
■抑制性抗菌治疗（SAT）在感染性心内膜炎（IE）管理中的作用尚未确定。本研究的目的是描述SAT在IE转诊中心的使用情况和患者的预后。
■我们在法国IE转诊中心（巴黎）进行了一项回顾性观察研究。纳入2016年至2022年期间接受SAT的所有IE患者。
■纳入42例患者（36例男性[86%]；中位年龄[四分位距{IQR}]，73[61-82]年）。中位Charlson合并症指数评分（IQR）为3（1-4）。40名患者（95％）有心脏内装置。最常见的微生物是粪肠球菌（15/42，36％）和金黄色葡萄球菌（12/42，29％）。尽管有临床指征，但SAT指征是没有手术（28/42，67%），假体材料去除不完全(6/42,14%),不受控制的感染源（4/42，10%），核成像持续异常摄取（1/42，2%），或先前适应症的组合（3/42，7%）。抗菌药物主要为强力霉素(19/42,45%)和阿莫西林(19/42,45%)。中位随访时间（IQR）为398（194-663）天。5例患者（12%）出现药物不良事件。五名患者（12%）在随访期间出现第二次IE发作，包括2次再感染（不同的细菌种类）和3次可能的复发（相同的细菌种类）。我们队列中有14名患者(33%)在随访期间死亡。总的来说,1年生存率为84.3%(73.5%-96.7%),无复发的1年生存率为74.1%(61.4%～89.4%)。
■SAT主要用于心脏装置患者，因为尽管有临床指征，但没有手术。报告了五次（12％）突破性的第二次IE发作。需要前瞻性的比较研究来指导这种经验实践。
■我们在法国IE转诊中心（巴黎）进行了一项回顾性观察研究。纳入2016年至2022年期间接受SAT的所有IE患者。
■纳入42例患者（36例男性[86%]；中位年龄[四分位距{IQR}]，73[61-82]年）。中位Charlson合并症指数评分（IQR）为3（1-4）。40名患者（95％）有心脏内装置。最常见的微生物是粪肠球菌（15/42，36％）和金黄色葡萄球菌（12/42，29％）。尽管有临床指征，但SAT指征是没有手术（28/42，67%），假体材料去除不完全(6/42,14%),不受控制的感染源（4/42，10%），核成像持续异常摄取（1/42，2%），或先前适应症的组合（3/42，7%）。抗菌药物主要为强力霉素(19/42,45%)和阿莫西林(19/42,45%)。中位随访时间（IQR）为398（194-663）天。5例患者（12%）出现药物不良事件。五名患者（12%）在随访期间出现第二次IE发作，包括2次再感染（不同的细菌种类）和3次可能的复发（相同的细菌种类）。我们队列中有14名患者(33%)在随访期间死亡。总的来说,1年生存率为84.3%(73.5%-96.7%),无复发的1年生存率为74.1%(61.4%～89.4%)。
■SAT主要用于心脏装置患者，因为尽管有临床指征，但没有手术。报告了五次（12％）突破性的第二次IE发作。需要前瞻性的比较研究来指导这种经验实践。
