Comment on: Streptococcal and enterococcal endocarditis: time for individualized antibiotherapy?

Giuliano, Simone; Angelini, Jacopo; Flammini, Sarah; Tascini, Carlo

doi:10.1093/jac/dkac109

Cited by 3 publications

(2 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Assuming that the ratio of the AUC of antibiotics in tissue to the AUC of the total serum concentration is linked to the ratio of diffusible (supposedly unbound) drug in tissue to the total concentration, most of the currently available studies about antibiotic penetration into heart valves are based upon high performance liquid chromatography (HPLC) methods [ 17 , 18 ]. On the one hand, HPLC has been developed widely in recent years and allows the precise determination of the concentrations of most drugs in various body fluids like blood [ 19 ], on the other hand, MALDI MS imaging (MSI) and micro dialysis (MD) techniques could represent better methods for visualizing and quantifying antibiotic penetration into the vegetation [ 20 ]. But these tools are still waiting for validation.…”

Section: Discussionmentioning

confidence: 99%

An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat Granulicatella adiacens Prosthetic Aortic Valve Endocarditis—Time to Change Paradigm?

Pagotto,

Campanile,

Conti

et al. 2024

Infectious Disease Reports

Self Cite

View full text Add to dashboard Cite

(1) Background: Granulicatella adiacens is a former nutritionally variant streptococci (NVS). NVS infective endocarditis (IE) is generally characterized by a higher rate of morbidity and mortality, partially due to difficulties in choosing the most adequate microbiological culture method and the most effective treatment strategy, and partially due to higher rates of complications, such as heart failure, peripheral septic embolism, and peri-valvular abscess, as well as a higher rate of valve replacement. Depending on the affected valve (native valve endocarditisNVE, or prosthetic valve endocarditisPVE), the American Heart Association (AHA) 2015 treatment guidelines (GLs) suggest penicillin G, ampicillin, or ceftriaxone plus gentamicin (2 weeks for NVE and up to 6 weeks for PVE), while vancomycin alone may be a reasonable alternative in patients who are intolerant of β-lactam therapy. The European Society of Cardiology (ESC) 2023 GLs recommend treating NVE with penicillin G, ceftriaxone, or vancomycin for 6 weeks, suggesting combined with an aminoglycoside (AG) for at least the first 2 weeks only for PVE; likewise, the same recommendations for IE due to Enterococcus faecalis. (2) Methods: Starting from the case of a 51-year-old man with G. adiacens aortic bio-prosthesis IE who was successfully treated with aortic valve replacement combined with double beta-lactams, an AG-sparing regimen, we performed microbiology tests in order to validate this potential treatment change. (3) Results: As for E. faecalis IE, we found that the combination of ampicillin plus cephalosporines (like ceftriaxone or ceftobiprole) showed a synergistic effect in vitro, probably due to wider binding to penicillin-binding proteins (PBPs), thus contributing to enhanced bacterial killing and good clinical outcome, as well as avoiding the risk of nephrotoxicity due to AG association therapy. (4) Conclusions: Further studies are required to confirm this hypothesis, but double beta-lactams and an adequate sourcecontrol could be a choice in treating G. adiacens IE.

show abstract

Section: Discussionmentioning

confidence: 99%

An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat Granulicatella adiacens Prosthetic Aortic Valve Endocarditis—Time to Change Paradigm?

Pagotto,

Campanile,

Conti

et al. 2024

Infectious Disease Reports

Self Cite

View full text Add to dashboard Cite

show abstract

“…TDM is even more essential in the setting of IE. Antibiotics penetrate poorly into the core of the vegetation in which drug concentration is supposed to be stable and in balance with the plasmatic concentration; thus, optimizing dose by means of TDM and, therefore, adjusting plasmatic and core intra-vegetation concentrations helps achieve microbiological and clinical cure [49,50]. Consistently, the clinical success rate was very high, accounting for 81% of patients, and microbiological cure was obtained in 86% of patients.…”

mentioning

confidence: 92%

Ampicillin and Ceftobiprole Combination for the Treatment of Enterococcus faecalis Invasive Infections: “The Times They Are A-Changin”

Giuliano,

Angelini,

D’Elia

et al. 2023

Antibiotics

Self Cite

View full text Add to dashboard Cite

Background: Enterococcus faecalis is responsible for a large variety of severe infections. This study is a case series reporting our experience in the treatment of E. faecalis invasive infections with ampicillin in combination with ceftobiprole (ABPR). Methods: We retrospectively analyzed all the medical records of patients admitted to the University Hospital of Udine from January to December 2020 with a diagnosis of infective endocarditis or primary or non-primary complicated or uncomplicated bacteremia caused by E. faecalis. Results: Twenty-one patients were included in the final analysis. The clinical success rate was very high, accounting for 81% of patients, and microbiological cure was obtained in 86% of patients. One relapse was recorded in one patient who did not adhere to the partial oral treatment prescribed. Therapeutic drug monitoring (TDM) was always performed for ampicillin and ceftobiprole, and serum concentrations of both drugs were compared to the MICs of the different enterococcal isolates. Conclusions: ABPR is a well-tolerated antimicrobial regimen with anti-E. faecalis activity. TDM can help clinicians optimize medical treatments to achieve the best possible efficacy with fewer side effects. ABPR might be a reasonable option for the treatment of severe invasive infections caused by E. faecalis due to the high level of enterococcal penicillin-binding protein (PBP) saturation.

show abstract

Streptococcal and enterococcal endocarditis: time for individualized antibiotherapy?—authors’ response

Flateau¹,

Riazi²,

Cassard³

et al. 2022

Journal of Antimicrobial Chemotherapy

View full text Add to dashboard Cite

Comment on: Streptococcal and enterococcal endocarditis: time for individualized antibiotherapy?

Cited by 3 publications

References 10 publications

An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat Granulicatella adiacens Prosthetic Aortic Valve Endocarditis—Time to Change Paradigm?

An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat Granulicatella adiacens Prosthetic Aortic Valve Endocarditis—Time to Change Paradigm?

Ampicillin and Ceftobiprole Combination for the Treatment of Enterococcus faecalis Invasive Infections: “The Times They Are A-Changin”

Streptococcal and enterococcal endocarditis: time for individualized antibiotherapy?—authors’ response

Contact Info

Product

Resources

About