Impact of <i>Enterococcus faecalis</i> Endocarditis Treatment on Risk of Relapse
Pierre Danneels, Jean‐François Hamel, Léa Picard, Schéhérazade Rezig, Pauline Martinet, A. Lorléac’h, Jean‐Philippe Talarmin, Rodolphe Buzelé, Thomas Guimard, G. Le Moal, Julia Brochard-Libois, Aurélie Beaudron, Julien Letheulle, Cyrielle Codde, Rachel Chenouard, David Boutoille, Adrien Lemaignen, Louis Bernard, Vincent Cattoir, Vincent Dubée, the EFEMER study group, Pierre Danneels, Vincent Dubée, Jean‐François Hamel, Marie Kempf, Rachel Chenouard, Camille Rihet, Clémence Vannier, Aurélie Beaudron, Lucia Perez, David Boutoille, Anne‐Gaëlle Leroy, Louis Bernard, Adrien Lemaignen, Marie Frédérique Lartigue, Cécile Le Brun, Vincent Cattoir, Matthieu Revest, Léa Picard, Léa Poussier, Camile Moaligou, Sophie Nogues, Asma Zouari Sassi, François Guérin, G. Le Moal, Chloé Plouzeau-Jayle, Jean-Philippe Talarmin, Marie-Sarah Fangous, Cyrielle Codde, Jean‐François Faucher, Julia Brochard-Libois, Thomas Guimard, Hélène Pelerin, Hélène Berthome, Rodolphe Buzelé, A. Lorléac’h, Schéhérazade Rezig, Pauline Martinet, Didier Jan, Julien Letheulle, Paul Le Turnier
Abstract
BACKGROUND: Enterococcus faecalis infective endocarditis (EFIE) is characterized by a higher frequency of relapses than other infective endocarditis. The role of the treatment on its occurrence remains poorly understood. The aim of this study was to investigate whether the antibiotic regimen could impact the risk of relapse in EFIE. MATERIALS: This was a multicenter retrospective study of patients diagnosed with definite EFIE between 2015 and 2019 in 14 French hospitals. The primary endpoint was the occurrence of relapses within the year following endocarditis diagnosis. As death was a competing risk for relapse, Fine and Gray models were used for studying risk factors and impact of treatment. RESULTS: Of the 279 patients included, 83 (29.7%) received the amoxicillin-gentamicin (A-G) combination, 114 (40.9%) amoxicillin-ceftriaxone (A-C), 63 (22.6%) A-G and A-C (A-G/A-C) sequentially, 9 (3.2%) amoxicillin (A), and 10 received other treatments. One-year-relapse rate was 9.3% (26 patients). Relapse occurred after a median delay of 107 days from EFIE diagnosis; 6 occurred after 6 months, and 6 were diagnosed by blood cultures in asymptomatic patients. In multivariate analysis, surgery during treatment was a protective factor against one-year relapse and death.The cumulative incidence of relapse 1 year after endocarditis was 46.2% for patients treated with amoxicillin, 13.4% with A-G, 14.7% with A-C, and 4.3% with A-G/A-C (P≥.05 in multivariate analysis). CONCLUSIONS: Relapses after treatment of EFIE are frequent, frequently asymptomatic, and may occur more than 6 months after the initial episode.