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Efficacy of teicoplanin monotherapy following initial standard therapy in Enterococcus faecalis infective endocarditis: a retrospective cohort study

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Abstract

Purpose

Teicoplanin is often used in Enterococcus faecalis infective endocarditis as a relay in case of penicillin side effects, or in outpatients. We assessed the efficacy of teicoplanin used as continuation therapy after initial standard treatment of E. faecalis endocarditis.

Methods

All adult patients consecutively diagnosed between 1997 and 2016 for E. faecalis endocarditis were retrospectively reviewed. Patients who received standard therapy (ST) were compared to those switched to teicoplanin to complete the treatment (teicoplanin therapy, TT).

Results

Seventy-one patients were enrolled: 34 in the ST group and 37 in the TT group. Amoxicillin was replaced by teicoplanin after a median duration of 18 days (IQ25 − 75 12–21). Teicoplanin (5.8 ± 2.3 mg/kg) was administered for a median duration of 29 days (IQ25 − 75 25–34). Gentamicin therapy was similar. Overall duration of antimicrobial therapy was 42 days (IQ25 − 75 35–43) in the ST group, and 46 days (IQ25 − 75 43–49) in the TT group (p = 0.001). Global and endocarditis-related mortality rates were 22/34 (65%) and 13/34 (38%) in the ST group, and 14/37 (38%) and 3/37 (8%) in the TT group (p ≤ 0.05). Relapses occurred in 2/26 patients who survived the treatment phase in the ST group (8%) and in 3/37 in the TT group (8%, p = 0.68). All relapses in the TT group occurred in patients presenting prosthetic valve endocarditis. Finally, 20 patients were cured in the ST group (59%), and 33 patients in the TT group (89%, p = 0.003).

Conclusions

In E. faecalis endocarditis, the switch to teicoplanin in selected patients following an initial phase of standard treatment represents an alternative, particularly for outpatient therapy. Caution should be exercised in cases of prosthetic valve endocarditis.

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Acknowledgements

We wish to thank Laurent CAVALIE, Department of Bacteriology, Toulouse University Hospital, France, for the pulsed-field gel electrophoresis analysis, Vanessa ROUSSEAU for her help in the statistical analysis, Marianne SACAZE for her precious technical assistance, Guillaume MOULIS for constructive criticisms on the manuscript, and Lydie PORTE, Guillaume ROBIN and Bertrand MARCHEIX representing the endocarditis team in our institution.

Funding

None to declare.

Author information

Authors and Affiliations

  1. Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse CEDEX 9, France

    Thomas De Nadaï, Bruno Marchou, Pierre Delobel & Guillaume Martin-Blondel

  2. Department of Internal Medicine, Lyon University Hospital, Lyon, France

    Mathilde François

  3. Department of Medical Pharmacology, Toulouse University Hospital, Toulouse, France

    Agnès Sommet

  4. INSERM Unité 1027, Toulouse, France

    Agnès Sommet

  5. Department of Bacteriology, Toulouse University Hospital, Toulouse, France

    Damien Dubois & Marion Grare

  6. IRSD, Toulouse University, INSERM, INRA, ENVT, UPS, Toulouse, France

    Damien Dubois & Marion Grare

  7. Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France

    David Metsu

  8. INTHERES UMR1436 INRA-ENVT, Toulouse, France

    David Metsu

  9. INSERM UMR1043 - CNRS UMR5282, Centre de Physiopathologie Toulouse Purpan, Toulouse, France

    Pierre Delobel & Guillaume Martin-Blondel

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  1. Thomas De Nadaï
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  2. Mathilde François
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Contributions

TDN and MF analysed data and wrote the manuscript; AS performed the statistical analysis; DD and MG analysed microbiological data; DM analysed therapeutic drug monitoring; and BM, PD and GMB supervised the project. All the authors contributed to the final version of the manuscript.

Corresponding author

Correspondence to Guillaume Martin-Blondel.

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All the authors confirm that they have no conflict of interest to declare.

Ethical approval

All the authors confirm that this study was performed in accordance with the Ethical Standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments. The approval of the Institutional Ethics Committee was obtained to carry out this study [CNIL (French Data Protection Act) 2151593v0].

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De Nadaï, T., François, M., Sommet, A. et al. Efficacy of teicoplanin monotherapy following initial standard therapy in Enterococcus faecalis infective endocarditis: a retrospective cohort study. Infection 47, 463–469 (2019). https://doi.org/10.1007/s15010-019-01290-w

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  • DOI: https://doi.org/10.1007/s15010-019-01290-w

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