Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Enterococcus faecalis infective endocarditis (EFIE) presents a higher relapse rate compared to other forms of infective endocarditis.
• The influence of antibiotic treatment regimens on EFIE relapse occurrence is not well understood.

Purpose of the Study:

• To evaluate the impact of different antibiotic regimens on the risk of relapse in patients with EFIE.
• To identify factors influencing relapse and mortality in EFIE.

Main Methods:

• A multicenter retrospective study involving 279 patients diagnosed with definite EFIE between 2015 and 2019.
• Fine and Gray models were employed to analyze risk factors for relapse, considering death as a competing risk.
• Patients received various antibiotic treatments including amoxicillin-gentamicin, amoxicillin-ceftriaxone, or sequential combinations.

Main Results:

• The overall one-year relapse rate was 9.3%.
• Sequential amoxicillin-gentamicin/amoxicillin-ceftriaxone therapy showed the lowest cumulative incidence of relapse (4.3%) at one year.
• Surgery during treatment was identified as a protective factor against one-year relapse and death.

Conclusions:

• Relapses in EFIE are common, frequently asymptomatic, and can manifest beyond six months post-diagnosis.
• The sequential administration of amoxicillin-gentamicin and amoxicillin-ceftriaxone appears to be associated with a reduced risk of relapse.
• Antibiotic regimen choice is a critical factor in managing EFIE and preventing recurrent episodes.