Comparative effectiveness of empirical antibiotic treatments in methicillin-susceptible Staphylococcus aureus infective endocarditis: a post hoc analysis of a prospective French cohort study
Résumé
Objectives: The empirical treatment of infective endocarditis is still debated. The aim of this study was to compare the impact of empirical treatment with antistaphylococcal penicillin (ASP) or cefazolin versus other treatments in methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis.
Methods: A post-hoc analysis of a prospective cohort study of patients hospitalized in a French reference center with MSSA endocarditis was conducted between 2013 and 2022. The primary outcome was the duration of bacteremia under treatment.
Results: Of the 208 patients included, 101 patients (48.6%) were classified in the reference group (ASP or cefazolin) and 107 (52.4%) in the non-reference group. Empirical treatment with ASP/cefazolin was associated with a shorter duration of bacteremia compared to other treatments (3.6 days versus 4.6 days, p=0.01). This difference was not corrected by the addition of an aminoglycoside (3.6 days versus 4.7 days, p<0.01). In multivariate analysis, empirical treatment with ASP/cefazolin was associated with a duration of bacteremia ≤72 hours (p=0.02), whereas endocarditis on native valves (p=0.01), and intracardiac abscess were associated with longer duration of bacteremia (p=0.01).
Conclusions: Empirical treatment of endocarditis with ASP or Cefazolin is more effective than other treatments in MSSA endocarditis, even when the other treatments are combined with aminoglycosides. Text.