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Antimicrobial management of Tropheryma whipplei endocarditis: the Spanish Collaboration on Endocarditis (GAMES)

Lara García-Álvarez1, M Mercedes Sanz1, Mercedes Marín2

  • 1Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain.

The Journal of Antimicrobial Chemotherapy
|February 22, 2019
PubMed
Abstract

Insights

Tropheryma whipplei endocarditis treatment showed effective and well-tolerated outcomes in Spanish patients. Shorter antimicrobial regimens may be sufficient, as no relapses or deaths occurred during long-term follow-up.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Tropheryma whipplei is a rare cause of infective endocarditis (IE), particularly in blood culture-negative cases.
  • Experience with T. whipplei endocarditis management is limited, necessitating further research into effective treatment strategies.

Purpose of the Study:

  • To evaluate the long-term outcomes of Tropheryma whipplei endocarditis treatment in Spanish patients.
  • To discuss potential antimicrobial therapy options for T. whipplei IE.

Main Methods:

  • A cohort of 17 patients with T. whipplei endocarditis was recruited across 25 Spanish hospitals between 2008 and 2014.
  • Patients received various treatment regimens, including ceftriaxone and trimethoprim/sulfamethoxazole, or doxycycline plus hydroxychloroquine.
  • Long-term follow-up data were collected for 14 patients, with a median follow-up of 46.5 months.

Main Results:

  • All treatment regimens were effective and well-tolerated, with no therapeutic failures during treatment.
  • No deaths or relapses were observed during the median 24-month follow-up period after treatment completion.
  • The median antibiotic treatment duration was 13 months, with some patients receiving longer courses.

Conclusions:

  • Tropheryma whipplei endocarditis can be effectively treated with various antimicrobial regimens.
  • Current data suggest that shorter antimicrobial treatments might be sufficient for T. whipplei IE.
  • Further research is warranted to establish optimal treatment durations and confirm the efficacy of shorter regimens.

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