High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis

Tissot-Dupont, Hervé; Gouriet, Frédérique; Oliver, Leopold; Jamme, Matthieu; Casalta, Jean-Paul; Jimeno, Marie-Thérèse; Arregle, Florent; Lavoute, Cécile; Hubert, Sandrine; Philip, Mary; Martel, Hélène; Riberi, Alberto; Habib, Gilbert; Raoult, Didier

High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis

2019

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20–30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.This before–after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001–2011) with the outcomes of 171 patients in the T&C group (2012–2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.

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