JAC Advance Access published online on September 30, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg440
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Microbiology, Green Lane Hospital, Auckland, New Zealand
* Corresponding author. E-mail: amorris{at}dml.co.nz.
Received 10 June 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 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
Bacteriological outcome of combination versus single-agent
treatment for staphylococcal endocarditis
2 Department of Biostatistics, Green
Lane Hospital, Auckland, New Zealand
14 days [49
(83%) of 59 versus 29 (31%) of 93; P < 0.001].
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