JAC Advance Access originally published online on September 30, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 820-825
© 2003 The British Society for Antimicrobial Chemotherapy
Bacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis
1Departments of 1 Microbiology and 2 Biostatistics, Green Lane Hospital, Auckland, New Zealand
Received 10 June 2003; returned 12 July 2003; revised 23 July 2003; accepted 11 August 2003
Objective: To analyse the bacteriological outcome of combination versus single-agent antimicrobial treatment in staphylococcal endocarditis.
Patients and methods: Retrospective review of 152 episodes: 91 cases of native valve endocarditis (NVE), 74 due to Staphylococcus aureus and 17 due to coagulase-negative staphylococci (CoNS); and 61 cases of prosthetic valve endocarditis (PVE), 29 due to S. aureus and 32 due to CoNS.
Results: Valves from patients with S. aureus NVE treated with any kind of combination antibiotic treatment were no more likely to be culture-negative than those treated with a single agent [19 (45%) of 42 versus 13 (41%) of 32; P = 0.69]. This finding remained unchanged when cases of CoNS NVE were added to the S. aureus group. In PVE, after adjusting for duration of treatment, valves from patients receiving any kind of combination treatment were 5.9 times (95% confidence interval 1.3–27.5) more likely to be culture-negative than those receiving monotherapy (P = 0.024). Patients treated for >14 days were more likely to be culture-negative than those treated for 
14 days [49 (83%) of 59 versus 29 (31%) of 93; P < 0.001].
Conclusions: In staphylococcal NVE, combination treatment is not superior to monotherapy in sterilizing infected valves, but in PVE combination treatment confers an advantage.
Keywords: coagulase-negative staphylococci, culture result, heart valves, Staphylococcus aureus, Staphylococcus epidermidis
* Correspondence address. Microbiology Laboratory, Auckland City Hospital, PO Box 110031, Auckland 1003, New Zealand. Tel: +649-571-4093; Fax: +649-571-4091; E-mail: amorris{at}dml.co.nz
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