Novel double beta-lactam therapy for Granulicatella adiacens infective endocarditis

Abstract

Granulicatella adiacens , a nutritionally variant streptococci (NVS) is a well described organism associated with endocarditis. Previously communicated cases have documented the use of double beta-lactam therapy with ampicillin and ceftriaxone to treat patients with infective endocarditis due to Enterococcus faecalis and Streptocossus pneumoniae . We describe the first case of Granulicatella adiacens infective endocarditis in a patient successfully treated with the combination of intravenous ampicillin and ceftriaxone and document their synergistic activity.

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

“…As recently described by Khan et al, it is possible that using AMP plus CRO therapy for G. adiacens IE, similarly to E. faecalis , may result in synergy, increased bacterial killing, and better clinical outcome, without the risk of nephrotoxicity due to AG use. In their study, the authors performed susceptibility testing using E-tests for AMP and CRO alone and in combination at standard concentrations, which demonstrated synergy (based on their FICindex) [ 7 ].…”

“…Depending on the affected valve (native or prosthetic), international GLs suggest treating G. adiacens IE with a combination therapy of beta-lactam plus gentamicin for 2 up to 6 weeks (with different classes and/or levels of recommendation), as in enterococcal endocarditis [5,6]. As reported in other experience [7], we tried to confirm that intravenous double beta-lactam combination therapy could result in good outcomes also for IE due to G. adiacens.…”