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

Abstract

Objective: The mortality rate from Staphylococcus aureus endocarditis remains as high as 20-30% despite better medical and surgical treatment. This study evaluates the efficiency and tolerance of a combination of trimethoprim-sulfamethoxazole and clindamycin (T&C) +/rifampicin and gentamicin, with rapid switch to oral T&C. Methods: Before-after intervention study to compare the outcome of 170 control patients before the introduction of the T&C protocol (2001 to 2011) to 171 patients in the T&C group (2012 to 2016). All patients diagnosed as S. aureus-infective endocarditis, and referred to our center between 2001 and 2016 were included. Between 2001 and 2011, the patients were given a standardized antibiotic treatment: oxacillin or vancomycin, for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol includes high dose of T&C (intravenously, switched to oral at day 7). Rifampicin and gentamicin can be added (if blood culture positive after 48 hours or cardiac abscess). Results:The two groups were slightly different. In intention to treat, the global mortality rate was lower in the T&C group (19.3% vs 30% -p=0.024), as well as the in-hospital mortality (9.9% vs 18.2% -p=0.03), and the 30-days mortality (7.1% vs 14.2% -p=0.05). The mean duration of hospital stay alive was significantly shorter in the T&C group (30 vs 39 days -p=0.005) Conclusions:The management of S. aureus IE in our multidisciplinary team, using a rapid shift to oral antibiotic with T&C, shows promising results reducing length of hospital stay and the mortality rate.

The extreme drug resistance (XDR) Staphylococcus aureus strains among patients: A retrospective study

“…Staphylococcus spp. (MRSA and non-MRSA) are considered susceptible to trimethoprim/sulfamethoxazole; however, several studies, including ours, have reported the isolation of trimethoprim/sulfamethoxazole-resistant MRSA and non-MRSA strains from patients ( Harris et al, 2018 , Sato et al, 2018 , Coombs et al, 2019 , Tissot-Dupont et al, 2019 ). In fact, mutability of the Staphylococcus strains, including MRSA strains is a very perplexing issue.…”

Molecular Characterization of Staphylococcus aureus Obtained from Blood Cultures of Paediatric Patients Treated in a Tertiary Care Hospital in Mexico

“…In turn, MRSA remains susceptible to lincosamides, which are second-line treatments for MRSA, at levels close to 50% of susceptibility. 45,46 Although VAN is the firstchoice antimicrobial for MRSA bacteraemia, 46 there are other treatment alternatives, such as LZD, SXT and CLI, in monotherapy or in combination with DAP or ceftaroline (CPT). [45][46][47][48] Therefore, interpretive reading of the antibiograms and the usage of first-choice antimicrobials are essential to reduce the risk of therapeutic failure and increase resistance rates.…”

Vancomycin, Daptomycin, Antistaphylococcal β-Lactam, and Trimethoprim-Sulfamethoxazole Monotherapy and Combination Therapy in the Management of Methicillin-Resistant Staphylococcus aureus: A Network Meta-Analysis

“…Some previous studies had reported similar results. Tissot-Dupont et al (2019) reported that TMP-SMX did not achieve noninferiority compared with vancomycin among patients with invasive MRSA infections. There were also some different conclusions.…”