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- Title
Antimicrobial management of Tropheryma whipplei endocarditis: the Spanish Collaboration on Endocarditis (GAMES) experience.
- Authors
García-Álvarez, Lara; Sanz, M Mercedes; Marín, Mercedes; Fariñas, M Carmen; Montejo, Miguel; Goikoetxea, Josune; García, Raquel Rodríguez; Alarcón, Arístides de; Almela, Manuel; Fernández-Hidalgo, Nuria; Socas, M Mar Alonso; Goenaga, Miguel A; Navas, Enrique; Vicioso, Luis; Oteo, José A; (GAMES), Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España; Rodríguez García, Raquel; de Alarcón, Arístides; Alonso Socas, M Mar; Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES)
- Abstract
<bold>Objectives: </bold>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.<bold>Patients and Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
SPAIN; ANTI-infective agents; ENDOCARDITIS; DOXYCYCLINE; CEFTRIAXONE; CO-trimoxazole; ANTIBIOTICS; COMBINATION drug therapy; GRAM-positive bacteria; INFECTIVE endocarditis; LONGITUDINAL method; TREATMENT effectiveness; PHARMACODYNAMICS
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2019, Vol 74, Issue 6, p1713
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkz059