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Background: The addition of an aminoglycoside to a β-lactam for the treatment of patients with infective endocarditis has been supported by data from laboratory and animal studies.Purpose: We sought to review the evidence from the available comparative clinical trials regarding the role of aminoglycosides in combination with a β-lactam for the treatment of bacterial endocarditis caused by Gram-positive cocci.Data sources: The studies for our meta-analysis were retrieved from searches of the PubMed and Cochrane Central Register of Controlled Trials databases, as well as from the references cited in relevant articles. No limits were set regarding the language and date of publication of the studies.Study selection: Included studies were prospective studies that provided comparative data regarding the effectiveness of the treatment and/or mortality in patients receiving monotherapy with a β-lactam or β-lactam/aminoglycoside combination therapy.Data extraction: Two independent reviewers performed the literature search, study selection and extraction of data from relevant studies.Data synthesis: No clinical trial comparing β-lactam monotherapy with β-lactam/aminoglycoside combination therapy for the treatment of enterococcal endocarditis was found. We performed a meta-analysis of five available comparative trials [four randomized controlled trials (RCTs) and one comparative prospective trial], which included 261 patients with bacterial endocarditis in native valves due to Staphylococcus aureus (four studies) or streptococci of the viridans group (one study). There was no statistically significant difference between β-lactam monotherapy and β-lactam/aminoglycoside combination therapy regarding mortality [odds ratio (OR) = 0.59, 95% confidence interval (95% CI) = 0.21–1.66], treatment success (OR = 1.25, 95% CI = 0.49–3.05), treatment success without surgery (OR = 1.66, 95% CI = 0.64–4.30) or relapse of endocarditis (OR = 0.79, 95% CI = 0.15–4.29). Nephrotoxicity was less common in the β-lactam monotherapy arm than in the β-lactam/aminoglycoside combination therapy arm (OR = 0.38, 95% CI = 0.16–0.88, P = 0.024). No difference between the two treatment arms was found in subanalyses of the four studies that included only patients with staphylococcal infections in terms of mortality (OR = 0.69, 95% CI = 0.26–1.86, fixed effects model), treatment success (OR = 1.27, 95% CI = 0.47–3.43, fixed effects model) or relapse (OR = 0.76, 95% CI = 0.12–4.92, fixed effects model).Limitations: The relatively small number of available comparative trials was the major limitation of this meta-analysis.Conclusions: The limited evidence from the available prospective comparative studies does not offer support for the addition of an aminoglycoside to β-lactam treatment of patients with endocarditis caused by Gram-positive cocci. A large multicentre RCT is necessary to reach a definitive conclusion on this issue. [ABSTRACT FROM AUTHOR]

Background The use of antimicrobial-impregnated central venous catheters (CVCs) for the prevention of CVC microbial colonization and catheter-related bloodstream infection (CRBSI) remains controversial. Methods We performed a meta-analysis of randomized controlled trials (RCTs) evaluating CRBSI and colonization of CVCs impregnated with rifampicin-based antimicrobial combinations. Our main analysis compared the occurrence of CRBSI with rifampicin/minocycline-impregnated CVCs with that of non-rifampicin-impregnated CVCs. The PubMed and Cochrane Central Register of Controlled Trials databases were searched (until October 2006). Results Eight RCTs were included in the analysis. The main analysis (seven RCTs) demonstrated that rifampicin/minocycline-impregnated CVCs were associated with fewer CRBSIs compared with catheters not impregnated with rifampicin/minocycline (OR 0.23, 95% CI 0.14–0.40). The same was true regarding colonization (OR 0.46, 95% CI 0.31–0.69). Further analysis, comparing rifampicin-based CVCs with non-rifampicin-impregnated CVCs, demonstrated superiority of rifampicin-based CVCs in reducing colonization (OR 0.38, 95% CI 0.24–0.62) and CRBSI (OR 0.24, 95% CI 0.14–0.40). Similar results, suggesting superiority of rifampicin/minocycline-impregnated CVCs, were noted in a subgroup analysis of colonization and CRBSIs in which rifampicin/minocycline-impregnated CVCs were compared with simple, non-tunnelled, non-antimicrobially impregnated CVCs, a subgroup analysis that was performed by excluding low quality RCTs, and a subgroup analysis for colonization comprising studies in which the sonication technique was used. No serious adverse events and no difference in mortality between the two treatment groups were reported. No clear conclusions can be made regarding the impact of the use of rifampicin/minocycline-impregnated CVCs on the development of antimicrobial resistance based on the available data. Conclusions The available evidence suggests that rifampicin/minocycline-impregnated CVCs are safe and effective in reducing the rate of catheter colonization and CRBSI. Further research should focus on the possible development of resistance and on pharmacoeconomic issues related to the use of rifampicin/minocycline-impregnated CVCs. [ABSTRACT FROM AUTHOR]