861. Aminoglycosides for Surgically Treated Enterococcal Endocarditis
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • idsa_poster.png (3.7 MB)
  • Background: For many decades, aminoglycosides (AG) have been a mainstay of treatment for enterococcal infective endocarditis (IE). However, it is unclear if addition of AG to cell wall-active agents is necessary in surgically treated patients. Many patients do not necessarily receive AG after surgery, for various reasons. The primary aim of this study was to determine if aminoglycoside treatment after surgery for enterococcal IE leads to better outcomes. Methods: This retrospective study included patients who underwent surgery for enterococcal IE between July 1, 2007 and July 1, 2014. Treatment was defined as receipt of 3 or more days of AG after surgery. Propensity to receive AG was calculated in a model that included native vs. prosthetic valve endocarditis, chronic kidney disease, high-level aminoglycoside resistance, metastatic infection, invasive disease (extending beyond annulus), positive valve culture, and creatinine on the day of surgery. Cox proportional hazards regression was used to compare the primary outcome of death or reoperation for IE, adjusted for age, sex, APR-DRG mortality risk score, and propensity to receive AG, among patients who did and did not receive AG treatment. Patients who did not have the primary outcome were censored on the date last known to be alive. Results: 108 patients with surgically treated enterococcal IE were identified. 27 patients (25%) received at least 3 days of AG after surgery. Mean age was 61 yrs, 63% were male, and 10% had HLAR. Patients treated with AG were more likely to have had positive valve cultures (OR 4.74, p=0.002). The median duration of treatment was 7 days (IQR 4-14 days). The median days to event was 491 days (IQR 93-991 days). In the multivariable Cox regression, patients treated with and without AG had a similar hazard of death (0.71, 95% CI 0.29-1.76). Results were similar if treatment was defined as any AG use after surgery, or AG continued at discharge from hospital. Conclusion: In patients with surgically treated enterococcal IE, there was insufficient evidence to suggest a survival benefit from treatment with aminoglycosides after surgery.
    Jona Banzon, MD1, Syed Hussain, MD2, Steven Gordon, MD, FIDSA, FSHEA1, Gosta Pettersson, MD, PhD2, Robert Butler, MS3 and Nabin Shrestha, MD, MPH, FIDSA, FSHEA1, (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, (3)Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH

    Disclosures:

    J. Banzon, None

    S. Hussain, None

    S. Gordon, None

    G. Pettersson, None

    R. Butler, None

    N. Shrestha, None

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