Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Staphylococcal prosthetic valve endocarditis (SPVE) poses a significant mortality risk.
• Standard treatment regimens often include β-lactam or vancomycin combined with rifampicin.
• The role of adjunctive gentamicin in SPVE treatment remains an area of clinical inquiry.

Purpose of the Study:

• To evaluate the impact of adding gentamicin to existing β-lactam or vancomycin plus rifampicin regimens.
• To determine if gentamicin influences survival outcomes in patients with SPVE.
• To analyze the association between gentamicin use and mortality in SPVE.

Main Methods:

• A retrospective study of 334 patients with definite SPVE from January 2008 to September 2016.
• Analysis of 94 patients receiving β-lactam or vancomycin plus rifampicin, with a subgroup receiving additional gentamicin.
• Multivariable analysis to assess the independent effect of gentamicin on mortality, adjusting for other factors.

Main Results:

• Of 94 patients, 77 received gentamicin and 17 did not. Overall mortality was 42.6%.
• Mortality rates were similar between the gentamicin (42.9%) and non-gentamicin (41.2%) groups (P=0.899).
• Gentamicin administration was not associated with mortality (OR: 1.001; CI 95%: 0.29-3.38) in multivariable analysis. Worsening renal function was also similar between groups.

Conclusions:

• Adding gentamicin to vancomycin or cloxacillin plus rifampicin for SPVE did not improve patient outcomes.
• The study found no significant association between gentamicin use and improved survival in SPVE.
• Factors like heart failure and delayed surgery were associated with increased mortality in SPVE patients.