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Special issues in the management of infective endocarditis caused by gram-positive cocci
1Service de Maladies Infectieuses et Tropicales, University of Besançon Medical Center, F-25030 Besançon, France. bruno.hoen@ufc-chu.univ-fcomte.fr
Abstract:
Gram-positive cocci, mainly streptococci and staphylococci, continue to cause the majority of cases of infective endocarditis. Among the streptococci causing IE, the long-standing predominance of oral or viridans-group streptococci has progressively faded, while the number of cases caused by "enteric streptococci" (Streptococcus bovis and enterococci) has increased. While most oral streptococci and S. bovis strains remain fully sensitive to penicillin, nutritionally variant streptococci--now renamed Abiotrophia--and enterococci can exhibit resistance to penicillin and/or glycopeptides that makes endocarditis more difficult to treat. Among the staphylococci causing endocarditis, the increasing proportion of coagulase-negative and methicillin-resistant strains observed in recent years has changed the approach to choice of antibiotic therapy. The purpose of this paper is to focus on some new aspects of the management of antibiotic therapy of IE due to streptococci and staphylococci, including recent developments such as once-daily aminoglycoside administration in IE, outpatient antibiotic therapy, and the evaluation of new antibiotics.
Insights
Infective endocarditis (IE) management is evolving due to changing bacterial resistance patterns. This review highlights new antibiotic strategies for streptococcal and staphylococcal IE.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Gram-positive cocci, primarily streptococci and staphylococci, are the leading causes of infective endocarditis (IE).
- There's a notable shift in etiological agents, with increasing cases of IE caused by "enteric streptococci" (e.g., enterococci) and a rise in antibiotic-resistant staphylococcal strains.
- Emerging resistance to penicillin and glycopeptides in certain streptococci (Abiotrophia, enterococci) and the prevalence of methicillin-resistant staphylococci complicate treatment protocols.
Purpose of the Study:
- To review and discuss novel approaches in antibiotic therapy for infective endocarditis caused by streptococci and staphylococci.
- To provide insights into recent advancements in managing IE, considering evolving microbial resistance.
Main Methods:
- Literature review focusing on recent developments in antibiotic therapy for IE.
- Analysis of trends in causative pathogens and their susceptibility patterns.
- Evaluation of new therapeutic strategies and antibiotic agents.
Main Results:
- The landscape of streptococcal IE is shifting, with a decrease in oral viridans-group streptococci and an increase in enterococci.
- Antibiotic resistance, particularly to penicillin and glycopeptides, is a growing concern in IE treatment.
- The increasing incidence of coagulase-negative and methicillin-resistant staphylococci necessitates adjustments in empirical and definitive antibiotic choices.
Conclusions:
- Current antibiotic strategies for IE must adapt to changing microbial epidemiology and resistance.
- Newer therapeutic modalities, including once-daily aminoglycoside dosing, outpatient parenteral antibiotic therapy (OPAT), and novel antibiotics, offer promising avenues for improved IE management.
- Continued research and clinical evaluation are crucial for optimizing antibiotic therapy in IE.