• Hervé Tissot-Dupont, Frédérique Gouriet, Leopold Oliver, Matthieu Jamme, Jean-Paul Casalta, Marie-Thérèse Jimeno, Florent Arregle, Cécile Lavoute, Sandrine Hubert, Mary Philip, Hélène Martel, Alberto Riberi, Gilbert Habib, and Didier Raoult.
• Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France.
• Int. J. Antimicrob. Agents. 2019 Aug 1; 54 (2): 143-148.

ObjectiveThe mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.MethodsThis before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.ResultsThe two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).ConclusionsThe management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.Copyright © 2019. Published by Elsevier B.V.

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