Enterococcal Endocarditis in Sweden, 1995–1999: Can Shorter Therapy with Aminoglycosides Be Used?
Abstract
A 5-year nationwide prospective study in Sweden during 1995-1999 identified 881 definite episodes of infective endocarditis. Definite enterococcal endocarditis was diagnosed in 93 episodes (11%), the largest series of enterococcal endocarditis so far presented. Mortality during treatment was 16%, the relapse rate was 3%, and clinical cure was achieved in the remaining 81% of the episodes. Clinical cure was achieved with a median duration of cell wall-active antimicrobial therapy of 42 days combined with an aminoglycoside (median treatment time, 15 days). International guidelines generally recommend a 4-6-week combined synergistic treatment course with a cell wall-active antibiotic and an aminoglycoside. Treatment regimens in Sweden often include a shortened aminoglycoside treatment course in order to minimize adverse effects in older patients. Fatal outcome seemed not to be due to the shortened aminoglycoside therapy course. In many enterococcal endocarditis episodes, duration of aminoglycoside therapy could probably be shortened to 2-3 weeks.
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In that study, the median duration of aminoglycoside therapy was 15 days, and microbiological cure and survival rates were similar to those for patients who received longer courses of gentamicin therapy.
“The median duration of aminoglycoside therapy was 15 days, and the microbiological cure and survival rates were similar to those for patients who received longer courses of gentamicin therapy.”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [189]
The Results (p. 3) report a median of 15 days of aminoglycoside therapy in episodes with clinical cure. The Discussion (pp. 6–7) describes good outcomes with shortened treatment, but our copy does not report similar microbiological-cure and survival rates compared with a longer-course gentamicin group; it discusses several aminoglycosides. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOlaison and Schadewitz reported a 5-year prospective study of 78 cases of enterococcal IE treated with a β-lactam and an aminoglycoside.
“Olaison and Schadewitz 189 in Sweden reported a 5-year prospective study of 78 cases of enterococcal IE treated with a β-lactam and an aminoglycoside.”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [189]
The paper describes a five-year prospective study in Sweden, but reports 93 definite enterococcal IE episodes, not 78; 78 is the number caused by E. faecalis (opening summary, p. 1; Results, p. 2). The Results (pp. 3, 5) also show that treatment varied: some patients received vancomycin, and seven received no aminoglycoside. Thus the stated treatment does not describe all cases. (LLM, conf=0.93)
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References 21 · Cited by 166
Research works printed but not linked: 1
- [17]17. Eliopoulos GE. Enterococcal endocarditis. In: Kaye D, ed. Infective endocarditis. 2nd ed. New York: Raven Press, 1992 :209-23.
- Authors
- Olaison, L., Schadewitz, K., & Swedish Society of Infectious Diseases Quality Assurance Study Group for Endocarditis
- Affiliations
- Sahlgrenska University Hospital (SE)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-01-15
- Volume
- 34
- Issue
- 2
- Pages
- 159-166
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2114714878
- Cited by
- 166
- References
- 21
- Citations by year
- 2026: 2 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 5 · 2018: 3 · 2017: 8 · 2016: 4 · 2015: 9 · 2014: 2 · 2013: 18 · 2012: 5
- FWCI
- 5.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- enterococcal endocarditis, cell wall-active antibiotics, mortality, relapse, clinical cure, treatment guidelines, elderly patients
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Aminoglycosides, Anti-Bacterial Agents, Drug Therapy, Combination, Endocarditis, Bacterial, Female, Heart Valve Prosthesis, Humans, Lactams, Male, Middle Aged, Prospective Studies, Streptococcal Infections, Streptococcus, Enterococcus faecalis, Sweden, Gram-Positive Bacterial Infections, Enterococcus faecium, Secondary Prevention
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