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

Garcia-Alvarez, L.; Sanz, M. M.; Marin, M.; Farinas, M. C.; Montejo, M.; Goikoetxea, J.; Garcia, R. R.; de Alarcon, A.; Almela, M.; Fernandez-Hidalgo, N.; Socas, M. M. A.; Goenaga, M. A.; Navas, E.; Vicioso, L.; Oteo, J. A.; Adan, I.; Sanchez, F. F.; Noureddine, M.; Rosas, G.; Lima, J. D.; Aramendi, J.; Bereciartua, E.; Boado, M. V.; Lazaro, M. C.; Goiti, J. J.; Hernandez, J. L.; Iruretagoyena, J. R.; Zuazabal, J. I.; Lopez-Soria, L.; Perez, P. M.; Rodriguez, R.; Voces, R.; Lopez, M. V. G.; Georgieva, R. I.; Solero, M. M.; Bailon, I. R.; Morales, J. R.; Cuende, A. M.; Echeverria, T.; Fuerte, A.; Gaminde, E.; Idigoras, P.; Iribarren, J. A.; Yarza, A. I.; Urkola, X. K.; Reviejo, C.; Carrasco, R.; Climent, V.; Llamas, P.; Merino, E.; Plazas, J.; Reus, S.; Alvarez, N.; Bravo-Ferrer, J. M.; Castelo, L.; Cuenca, J.; Llinares, P.; Rey, E. M.; Mayo, M. R.; Sanchez, E.; Regueiro, D. S.; Martinez, F. J.; Alonso, M. D.; Castro, B.; Marrero, D. G.; Duran, M. D.; Gomez, M. A. M.; La Calzada, J.; Nassar, I.; Ciezar, A. P.; Iglesias, J. M. R.; Alvarez, V. A.; Costas, C.; de la Hera, J.; Suarez, J. F.; Fraile, L. I.; Arguero, V. L.; Menendez, J. L.; Bajo, P. M.; Morales, C.; Torrico, A. M.; Palomo, C.; Martinez, B. P.; Esteban, A. R.; Asensio, M. T.; Ambrosioni, J.; Armero, Y.; Azqueta, M.; Brunet, M.; Cartana, R.; Falces, C.; Fita, G.; Fuster, D.; de la Maria, C. G.; Gatell, J. M.; Perez, J. L.; Manzardo, C.; Marco, F.; Miro, J. M.; Moreno, A.; Ninot, S.; Quintana, E.; Pare, C.; Pereda, D.; Pericas, J. M.; Pomar, J. L.; Ramirez, J.; Rovira, I.; Sitges, M.; Soy, D.; Tellez, A.; Vidal, B.; Vila, J.; Bermejo, J.; Bouza, E.; Cuerpo, G.; de Egea, V.; Eworo, A.; Cruz, A. F.; Leoni, M. E. G.; del Vecchio, M. G.; Ramallo, V. G.; Hernandez, M. K.; Martinez-Selles, M.; Menarguez, M. C.; Munoz, P.; Rincon, C.; Rodriguez-Abella, H.; Rodriguez-Creixems, M.; Pinilla, B.; Pinto, A.; Valerio, M.; Moreno, E. V.; Antorrena, I.; Loeches, B.; Moreno, M.; Ramirez, U.; Baston, V. R.; Romero, M.; Saldana, A.; Castillo, C. A.; Arnaiz, A.; Berrazueta, J.; Bellisco, S.; Belaustegui, M. C.; Duran, R.; Farinas-Alvarez, C.; Mazarrasa, C. F.; Izquierdo, R. G.; Rico, C. G.; Diez, J. G.; Duran, R. M.; Pajaron, M.; Parra, J. A.; Teira, R.; Zarauza, J.; Pavia, P. G.; Gonzalez, J.; Orden, B.; Ramos, A.; Gonzalez, E. R.; Centella, T.; Hermida, J. M.; Moya, J. L.; Martin-Davila, P.; Oliva, E.; del Rio, A.; Ruiz, S.; Tenorio, C. H.; de Castro, A.; de Cueto, M.; Gallego, P.; Acebal, J. G.; Bano, J. R.; Garcia, E.; Haro, J. L.; Lepe, J. A.; Lopez, F.; Luque, R.; Alonso, L. J.; Azcarate, P.; Gutierrez, J. M. A.; Blanco, J. R.; de Benito, N.; Gurgui, M.; Pacho, C.; Pericas, R.; Pons, G.; Alvarez, M.; Fernandez, A. L.; Martínez Monzonís, Maria Amparo; Prieto, A.; Regueiro García, Benito José; Tijeira, E.; Vega Fernandez, Marino; Blasco, A. C.; Mollar, J. C.; Arana, J. C. G.; Uriarte, O. G.; Lopez, A. M.; de Zarate, Z. O.; Matos, J. A. U.; Nacle, M. B.; Sanchez-Porto, A.; Vallejo, L.; Leal, J. M. A.; Vazquez, E. G.; Torres, A. H.; Blazquez, A.; Valenzuela, G. D.; Alonso, A.; Aramburu, J.; Calvo, F. E.; Rodriguez, A. M.; Tarabini-Castellani, P.; Galvez, E. H.; Bellido, C. M.; Pau, J. L.; Sepulveda, M. A.; Sierra, P. T.; Iqbal-Mirza, S. Z.; Alcolea, E. C.; Serrano, P. E.; Roca, J. J. H.; Escobar, E. M.; Monje, A. P.; Cabrera, V. S.; Garcia, D. V.; Luna, C. C.; Morcillo, J. N.; Seco, M. C. P.; Spanish Collaboration, Endocarditis
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Identifiers
URI: http://hdl.handle.net/20.500.11940/15639
PMID: 30789210
ISSN: 0305-7453
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Date issued
2019
Journal title
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Type of content
Artigo
DeCS
resultado del tratamiento | anciano | endocarditis | estudios de seguimiento | Tropheryma | mediana edad | farmacoterapia | humanos | antibacterianos
MeSH
Drug Therapy | Endocarditis | Middle Aged | Humans | Treatment Outcome | Follow-Up Studies | Tropheryma | Anti-Bacterial Agents | Aged
Abstract
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 Espana (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.