TY - JOUR
T1 - Antimicrobial therapy and outcome of methicillin-resistant Staphylococcus aureus endocarditis
T2 - A retrospective multicenter study in Japan
AU - Mitsutake, Kotaro
AU - Shinya, Natsuki
AU - Seki, Masafumi
AU - Ohara, Takahiro
AU - Uemura, Kohei
AU - Fukunaga, Masato
AU - Sakai, Jun
AU - Nagao, Miki
AU - Sata, Makoto
AU - Hamada, Yohei
AU - Kawasuji, Hitoshi
AU - Yamamoto, Yoshihiro
AU - Nakamatsu, Masashi
AU - Koizumi, Yusuke
AU - Mikamo, Hiroshige
AU - Ukimura, Akira
AU - Aoyagi, Tetsuji
AU - Sawai, Toyomitsu
AU - Tanaka, Takeshi
AU - Izumikawa, Koichi
AU - Takayama, Yoko
AU - Nakamura, Kiwamu
AU - Kanemitsu, Keiji
AU - Tokimatsu, Issei
AU - Nakajima, Kazuhiko
AU - Akine, Dai
N1 - Publisher Copyright:
© 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control
PY - 2024/9
Y1 - 2024/9
N2 - Background: MRSA (methicillin-resistant Staphylococcus aureus)-infective endocarditis (IE) is associated with high morbidity and mortality. This study aimed to assess data from patients with MRSA-IE across multiple facilities in Japan, with a specific focus on antimicrobial therapy and prognosis. Methods: This retrospective study enrolled patients with a confirmed diagnosis of IE attributed to MRSA, spanning the period from January 2015 to April 2019. Results: Sixty-four patients from 19 centers were included, with a median age of 67 years. The overall mortality rate was 28.1% at 30 days, with an in-hospital mortality of 45.3%. The most frequently chosen initial anti-MRSA agents were glycopeptide in 67.2% of cases. Daptomycin and linezolid were selected as initial therapy in 23.4% and 17.2% of cases, respectively. Approximately 40% of all patients underwent medication changes due to difficulty in controlling infection or drug-related side effects. Significant prognostic factors by multivariable analysis were DIC for 30-day mortality and surgical treatment for 30-day and in-hospital mortality. For vancomycin as initial monotherapy, there was a trend toward a worse prognosis for 30-day and in-hospital mortality (OR, 6.29; 95%CI, 1.00–39.65; p = 0.050, OR, 3.61; 95%CI, 0.93–14.00; p = 0.064). Regarding the choice of initial antibiotic therapy, statistical analysis did not show significant differences in prognosis. Conclusion: Glycopeptide and daptomycin were the preferred antibiotics for the initial therapy of MRSA-IE. Antimicrobial regimens were changed for various reasons. Prognosis was not significantly affected by choice of antibiotic therapy (glycopeptide, daptomycin, linezolid), but further studies are needed to determine which antimicrobials are optimal as first-line agents.
AB - Background: MRSA (methicillin-resistant Staphylococcus aureus)-infective endocarditis (IE) is associated with high morbidity and mortality. This study aimed to assess data from patients with MRSA-IE across multiple facilities in Japan, with a specific focus on antimicrobial therapy and prognosis. Methods: This retrospective study enrolled patients with a confirmed diagnosis of IE attributed to MRSA, spanning the period from January 2015 to April 2019. Results: Sixty-four patients from 19 centers were included, with a median age of 67 years. The overall mortality rate was 28.1% at 30 days, with an in-hospital mortality of 45.3%. The most frequently chosen initial anti-MRSA agents were glycopeptide in 67.2% of cases. Daptomycin and linezolid were selected as initial therapy in 23.4% and 17.2% of cases, respectively. Approximately 40% of all patients underwent medication changes due to difficulty in controlling infection or drug-related side effects. Significant prognostic factors by multivariable analysis were DIC for 30-day mortality and surgical treatment for 30-day and in-hospital mortality. For vancomycin as initial monotherapy, there was a trend toward a worse prognosis for 30-day and in-hospital mortality (OR, 6.29; 95%CI, 1.00–39.65; p = 0.050, OR, 3.61; 95%CI, 0.93–14.00; p = 0.064). Regarding the choice of initial antibiotic therapy, statistical analysis did not show significant differences in prognosis. Conclusion: Glycopeptide and daptomycin were the preferred antibiotics for the initial therapy of MRSA-IE. Antimicrobial regimens were changed for various reasons. Prognosis was not significantly affected by choice of antibiotic therapy (glycopeptide, daptomycin, linezolid), but further studies are needed to determine which antimicrobials are optimal as first-line agents.
KW - Antimicrobial therapy
KW - Endocarditis
KW - Glycopeptide
KW - Methicillin-resistant Staphylococcus aureus
UR - http://www.scopus.com/inward/record.url?scp=85187983855&partnerID=8YFLogxK
U2 - 10.1016/j.jiac.2024.02.027
DO - 10.1016/j.jiac.2024.02.027
M3 - 学術論文
C2 - 38432557
AN - SCOPUS:85187983855
SN - 1341-321X
VL - 30
SP - 860
EP - 866
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
IS - 9
ER -