Enterococcus Faecalis Infective Endocarditis: A Pilot Study on the Relationship between Duration of Gentamicin Treatment and Outcome
Background—Due to the nephrotoxic effects of aminoglycosides the Danish guidelines on infective endocarditis (IE) were changed in January 2007 reducing gentamicin treatment in enterococcal IE from 4-6 weeks to only 2 weeks. In this pilot study we compare the outcome in patients with enterococcus faecalis IE treated in the years before and after endorsement of these new recommendations.
Methods and Results—A total of 84 consecutive patients admitted with definite left-sided enterococcus faecalis endocarditis in the period 2002 to 2011 were enrolled. Forty-one patients were treated before, and 43 patients after January 1st, 2007, respectively. There were no significant differences in baseline characteristics. At hospitalization the two groups had similar eGFR of 66 ml/min vs. 75 ml/min (p=0.22). Patients treated before January 2007 received gentamicin for a significantly longer period (28 days vs. 14 days, p<0.001). The primary outcome, 1-year event-free survival, did not differ: 66 % vs. 69 % (p=0.75). At discharge the patients treated before 2007 had a lower eGFR of 45 ml/min vs. 66 ml/min (p=0.008), and a significantly greater decrease in eGFR: median 11ml/min vs. 1 ml/min (p=0.009).
Conclusions—Our present pilot study suggests that a recommendation of 2 weeks gentamicin treatment seem adequate and preferable in treating non HLAR enterococcus faecalis infective endocarditis. The longer duration of gentamicin treatment is associated with worse renal function and although the certainty of the clinical outcomes is limited by the sample size, outcomes appear to be no worse. Randomized controlled studies are warranted in order to substantiate these results.
- Received January 12, 2013.
- Revision received February 18, 2013.
- Accepted March 5, 2013.