未经证实:主要基于体外和动物模型,几乎没有直接解决患者结果的数据,目前的指南推荐使用庆大霉素和利福平等抗生素联合治疗葡萄球菌性人工瓣膜心内膜炎(PVE).这里,我们综合了葡萄球菌PVE中辅助利福平和庆大霉素的临床数据。
UNASSIGNED:我们对PubMed和Cochrane索引研究进行了系统评价和荟萃分析,这些研究报告了用利福平辅助治疗的葡萄球菌PVE,庆大霉素,两位特工,或者两者都没有(即,糖肽或β-内酰胺单一疗法)。我们记录了结果,包括死亡率,复发性感染,逗留时间,肾毒性,肝毒性,和重要的药物-药物相互作用(DDIs)。
未经评估:确定了四项相关研究。两项研究(n=117)表明,在含利福平的方案中添加庆大霉素并不能减少临床失败(比值比[OR],0.98[95%置信区间{CI},.39-2.46]),和2项研究(n=201)表明,在含庆大霉素的方案中添加利福平并不能减少临床失败(OR,1.29[95%CI,.71-2.33])。庆大霉素和利福平均不与减少感染复发相关;1项研究发现利福平治疗与住院时间延长相关(平均,31.3天vs42.3天;P<.001)。比较安全性结果很少报告,但一项研究发现利福平与肝毒性有关,肾毒性,DDIs,导致31%的患者停止治疗。
UNASSIGNED:现有的临床数据没有表明庆大霉素或利福平对葡萄球菌PVE的辅助作用。鉴于其他研究也表明这些药物会增加肾毒性,肝毒性,和DDI在葡萄球菌血管内感染中没有益处的风险,我们建议将庆大霉素和利福平用于PVE的建议降级,主要用于临床试验.
UNASSIGNED: Based primarily on in vitro and animal models, with little data directly addressing patient outcomes, current guidelines recommend treating staphylococcal prosthetic valve endocarditis (PVE) with antibiotic combinations including
gentamicin and rifampin. Here, we synthesize the clinical data on adjunctive rifampin and
gentamicin in staphylococcal PVE.
UNASSIGNED: We conducted a systematic
review and meta-analysis of PubMed- and Cochrane-indexed studies reporting outcomes of staphylococcal PVE treated with adjunctive rifampin,
gentamicin, both agents, or neither (ie, glycopeptide or β-lactam monotherapy). We recorded outcomes including mortality, relapsed infection, length of stay, nephrotoxicity, hepatotoxicity, and important drug-drug interactions (DDIs).
UNASSIGNED: Four relevant studies were identified. Two studies (n = 117) suggested that adding
gentamicin to rifampin-containing regimens did not reduce clinical failure (odds ratio [OR], 0.98 [95% confidence interval {CI}, .39-2.46]), and 2 studies (n = 201) suggested that adding rifampin to gentamicin-containing regimens did not reduce clinical failure (OR, 1.29 [95% CI, .71-2.33]). Neither gentamicin nor rifampin was associated with reduced infection relapse; 1 study found that rifampin treatment was associated with longer hospitalizations (mean, 31.3 vs 42.3 days; P < .001). Comparative safety outcomes were rarely reported, but 1 study found rifampin to be associated with hepatoxicity, nephrotoxicity, and DDIs, leading to treatment discontinuation in 31% of patients.
UNASSIGNED: The existing clinical data do not suggest a benefit of either adjunctive gentamicin or rifampin in staphylococcal PVE. Given that other studies also suggest these agents add nephrotoxicity, hepatoxicity, and risk of DDIs without benefit in staphylococcal endovascular infections, we suggest that recommendations for gentamicin and rifampin in PVE be downgraded and primarily be used within the context of clinical trials.