title: Antistaphylococcal β-Lactams versus Vancomycin for Treatment of Infective Endocarditis Due to Methicillin-Susceptible Coagulase-Negative Staphylococci: a Prospective Cohort Study from the International Collaboration on Endocarditis.
abstract: The phenotypic expression of methicillin resistance among coagulase-negative staphylococci (CoNS) is heterogeneous regardless of the presence of the mecA gene. The potential discordance between phenotypic and genotypic results has led to the use of vancomycin for the treatment of CoNS infective endocarditis (IE) regardless of methicillin MIC values. In this study, we assessed the outcome of methicillin-susceptible CoNS IE among patients treated with antistaphylococcal β-lactams (ASB) versus vancomycin (VAN) in a multicenter cohort study based on data from the International Collaboration on Endocarditis (ICE) Prospective Cohort Study (PCS) and the ICE-Plus databases. The ICE-PCS database contains prospective data on 5,568 patients with IE collected between 2000 and 2006, while the ICE-Plus database contains prospective data on 2,019 patients with IE collected between 2008 and 2012. The primary endpoint was in-hospital mortality. Secondary endpoints were 6-month mortality and survival time. Of the 7,587 patients in the two databases, there were 280 patients with methicillin-susceptible CoNS IE. Detailed treatment and outcome data were available for 180 patients. Eighty-eight patients received ASB, while 36 were treated with VAN. In-hospital mortality (19.3% versus 11.1%; P = 0.27), 6-month mortality (31.6% versus 25.9%; P = 0.58), and survival time after discharge (P = 0.26) did not significantly differ between the two cohorts. Cox regression analysis did not show any significant association between ASB use and the survival time (hazard ratio, 1.7; P = 0.22); this result was not affected by adjustment for confounders. This study provides no evidence for a difference in outcome with the use of VAN versus ASB for methicillin-susceptible CoNS IE.
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA manuela.carugati@duke.edu.
authors.forename: M
authors.initials: M
authors.lastname: Carugati
authors.affiliation: Departments of Medicine and Pathology, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Petti
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: C
authors.initials: C
authors.lastname: Arnold
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Miro
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Pericàs
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Garcia de la Maria
authors.affiliation: Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon.
authors.forename: Z
authors.initials: Z
authors.lastname: Kanafani
authors.affiliation: University of Naples SUN, Monaldi Hospital, Naples, Italy.
authors.forename: E
authors.identifier: 0000-0002-5381-3537
authors.initials: E
authors.lastname: Durante-Mangoni
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: J
authors.initials: J
authors.lastname: Baddley
authors.affiliation: Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: D
authors.initials: D
authors.lastname: Wray
authors.affiliation: Department of Infectious Diseases, St. Thomas' Hospital, London, United Kingdom.
authors.forename: J L
authors.initials: JL
authors.lastname: Klein
authors.affiliation: Hospices Civils de Lyon, Université Claude Bernard, Equipe d'Accueil HESPER 7425, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Fernandez-Hidalgo
authors.affiliation: Department of Microbiology, Mater Misericordiae University and Mater Private-Hospitals, Dublin, Ireland.
authors.forename: M M
authors.initials: MM
authors.lastname: Hannan
authors.affiliation: University of Otago, Christchurch, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Murdoch
authors.affiliation: LA Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA, and Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bayer
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: V H
authors.initials: VH
authors.lastname: Chu
mesh_terms: D000368:Aged; D003030:Coagulase / Q000378:metabolism; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D008875:Middle Aged; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D013210:Staphylococcus / Q000187:drug effects / Q000378:metabolism / Q000472:pathogenicity*; D014640:Vancomycin / Q000627:therapeutic use*; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D003030:Coagulase; D047090:beta-Lactams; D014640:Vancomycin; D008712:Methicillin