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Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose

The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration.

Objectives

To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection.

Methods

This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period.

Results

The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively).

Conclusions

Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to personal health information (PHI) confidentiality issues but are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Heather G Miller for her editorial assistance. Graphical abstract was made with BioRender.

Author information

Authors and Affiliations

  1. Service de Microbiologie, Unité Mobile d’Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France

    S. B. Gressens, I. Podglajen, J. L. Mainardi, D. Lebeaux & M. Dubert

  2. Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique – Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France

    B. Souhail & R. Lepeule

  3. Service de Microbiologie, Unité Mobile d’Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    B. Pilmis & J. Lourtet-Hascoët

  4. Université Paris Cité, Paris, France

    I. Podglajen, J. L. Mainardi, D. Lebeaux & M. Dubert

  5. Service de Chirurgie Cardiaque, Hôpitaux Universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris, 94000, Créteil, France

    A. Fiore

  6. EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France

    V. Fihman & R. Lepeule

  7. Département de Prévention, Diagnostic, et Traitement des Infections, Unité de Bactériologie – Hygiène, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Créteil, France

    V. Fihman

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  1. S. B. Gressens
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Simon B. Gressens, B. Souhail, and B. Pilmis. Analysis was performed by Simon B. Gressens, M. Dubert, and D. Lebeaux. The first draft of the manuscript was written by Simon B. Gressens and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to S. B. Gressens.

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Competing interests

JLM received consulting fees from BioAster (member of the Scientific Committee) and MSD Merck Sharp & Dohme AG (member of the advisory board). All other authors declare no competing interests.

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Gressens, S.B., Souhail, B., Pilmis, B. et al. Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration. Eur J Clin Microbiol Infect Dis 43, 95–104 (2024). https://doi.org/10.1007/s10096-023-04705-7

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