Antimicrobial management of Tropheryma whipplei endocarditis: the Spanish Collaboration on Endocarditis (GAMES) experience.

Autor:	García-Álvarez L; Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain., Sanz MM; Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain., Marín M; Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Fariñas MC; Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain., Montejo M; Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, Bilbao, Spain., Goikoetxea J; Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, Bilbao, Spain., Rodríguez García R; Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Universidad de Oviedo, Oviedo, Spain., de Alarcón A; Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Almela M; Servicio de Microbiología y Parasitología, Hospital Clinic de Barcelona, Barcelona, Spain., Fernández-Hidalgo N; Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain., Alonso Socas MM; Servicio de Enfermedades Infecciosas, Hospital Universitario de Canarias, Tenerife, Spain., Goenaga MA; Servicio de Enfermedades Infecciosas, Hospital Donostia, OSI Donostialdea, San Sebastián, Gipuzkoa, Spain., Navas E; Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain., Vicioso L; Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain., Oteo JA; Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2019 Jun 01; Vol. 74 (6), pp. 1713-1717.
DOI:	10.1093/jac/dkz059
Abstrakt:	Objectives: Tropheryma whipplei has been detected in 3.5% of the blood culture-negative cases of endocarditis in Spain. Experience in the management of T. whipplei endocarditis is limited. Here we report the long-term outcome of the treatment of previously reported patients who were diagnosed with infective endocarditis (IE) caused by T. whipplei from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) and discuss potential options for antimicrobial therapy for IE caused by T. whipplei. Patients and Methods: Seventeen patients with T. whipplei endocarditis were recruited between 2008 and 2014 in 25 Spanish hospitals. Patients were classified according to the therapeutic regimen: ceftriaxone and trimethoprim/sulfamethoxazole, doxycycline + hydroxychloroquine and other treatment options. Results: Follow-up data were obtained from 14 patients. The median follow-up was 46.5 months. All patients completed the antibiotic treatment prescribed, with a median duration of 13 months. Six patients were treated with ceftriaxone and trimethoprim/sulfamethoxazole (median duration 13 months), four with doxycycline + hydroxychloroquine (median duration 13.8 months) and four with other treatment options (median duration 22.3 months). The follow-up after the end of the treatments was between 5 and 84 months (median 24 months). Conclusions: All treatment lines were effective and well tolerated. Therapeutic failures were not detected during the treatment. None of the patients died or experienced a relapse during the follow-up. Only six patients received antibiotic treatment in accordance with guidelines. These data suggest that shorter antimicrobial treatments could be effective. (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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