Teicoplanin for treating enterococcal infective endocarditis: A retrospective observational study from a referral centre in Spain.

Highlights • Teicoplanin (TEC) can be used as an alternative first-line treatment in E. faecium infective endocarditis (IE). • TEC may be salvage therapy in select E. faecalis IE patients having adverse events with standard regimens or to allow OPAT. • There were no relapses when using TEC in this cohort of 22 episodes of enterococcal IE. ABSTRACT This study aimed to evaluate the effectiveness and safety of teicoplanin for treating enterococcal infective endocarditis (EIE). A retrospective analysis of a prospective cohort of definite EIE patients treated with teicoplanin in a Spanish referral centre (2000–2017) was performed. The primary outcome was mortality during treatment. Secondary outcomes were mortality during 3-month follow-up, adverse effects and relapse. A total of 22 patients received teicoplanin, 9 (40.9%) as first-line (8 Enterococcus faecium and 1 Enterococcus faecalis) and 13 (59.1%) as salvage therapy (13 E. faecalis). Median (IQR) age was 71.5 (58.3–78) years and Charlson comorbidity index was 4.5 (3–7). Five (22.7%) affected prosthetic valves. Median duration of treatment in survivors was 53 (42.5–61) days for antibiotics and 27 (17–41.5) days for teicoplanin [median dose 10 (10–10.8) mg/kg/day]. Reasons for teicoplanin use were resistance to β-lactams (40.9%), adverse events with previous regimens (31.8%) and outpatient parenteral antimicrobial therapy (OPAT) (27.3%). Teicoplanin was withdrawn due to adverse events in 2 patients (9.1%). Five patients (22.7%) died during treatment: four in the first-line (three with surgery indicated but not performed) and one in the salvage therapy group (surgery indicated but not performed). Two deaths (11.8%) occurred over the 3-month follow-up. There were no relapses during a median of 43.2 (22.1–69.1) months. Teicoplanin can be used as an alternative treatment for susceptible E. faecium IE and as a salvage therapy in selected patients with E. faecalis IE when adverse events develop with standard regimens or to allow OPAT. [ABSTRACT FROM AUTHOR]