Infective endocarditis caused by penicillin-resistant viridans group streptococci: a series of nine cases from a Spanish cohort.
J Antimicrob Chemother
; 2024 Oct 01.
Article
in En
| MEDLINE
| ID: mdl-39351977
ABSTRACT
BACKGROUND:
Infective endocarditis (IE) caused by viridans and gallolyticus group streptococci (VGS-GGS) resistant to penicillin (PEN-R; minimum inhibitory concentration ≥4â mg/L) is rare but poses therapeutic challenges.OBJECTIVES:
To describe the characteristics of patients with IE caused by PEN-R VGS-GGS, focusing on antimicrobial management.METHODS:
Retrospective analysis of a prospective cohort of definite IE caused by PEN-R VGS-GGS between 2008 and 2023 in 40 Spanish hospitals. We describe clinical characteristics, management and outcome of the cases, and compare them to IE caused by VGS-GGS with susceptibility or susceptibility with increased exposure to penicillin (PEN-I).RESULTS:
We identified nine cases of PEN-R VGS-GGS IE in a cohort of 1563 streptococcal IE (0.58%). All isolates belonged to S. mitis group. Three cases died during hospitalization and no relapse occurred at 3â months of follow-up. Compared to cases with susceptibility or PEN-I, PEN-R showed a higher rate of mitral location (78% versus 51%), surgical indication (67% versus 51%), and in-hospital mortality (33% versus 12%). Most cases (86%) showed resistance to third-generation cephalosporins. The preferred antibiotic regimen was beta-lactam-based ceftriaxone plus gentamicin, penicillin plus gentamicin, ceftriaxone plus levofloxacin, and ceftaroline plus daptomycin. Two cases received a combination of vancomycin plus gentamicin. Levofloxacin was used in two cases in combination with ceftriaxone or daptomycin. All patients that received cardiac surgery were cured at the end of follow-up.CONCLUSIONS:
IE caused by PEN-R VGS-GGS was rare and only affected mitis group streptococci. Antibiotic combination including a beta-lactam seems to be effective in its management.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
J Antimicrob Chemother
Year:
2024
Document type:
Article
Affiliation country:
Spain
Country of publication:
United kingdom