Work

2410. Clinical outcomes and antimicrobial management strategies of Pseudomonas endocarditis

Year: 2023

Type: article

Abstract: Background Infective endocarditis secondary to Pseudomonas is rare. Our objective was to investigate outcomes of patients with Pseudomonas endocarditis by treatment strategy and identify factors associated with treatment failure. Methods Adult patients with definitive Pseudomonas endocarditis at 8 hospitals were identified between July 2010 and December 2022. Unless the cultured valve yielded a Gram-negative pathogen, patients with blood cultures growing Gram-positive bacteria or yeast for >24 hours were excluded. Combination therapy was defined as receipt of ≥2 in vitro active agents for ≥72 hours. Failure was a defined as death or microbiologic failure by day 42; microbiologic failures included escalation of antimicrobial therapy following treatment-emergent resistance, increased vegetation size, or blood cultures positive for ≥14 days. Results 34 patients met the inclusion criteria. 32% (11/34) were people who inject drugs and 12% (4/34) were organ transplant recipients. P. aeruginosa was the underlying pathogen in 97% (33/34) of patients. 65% (22/34) and 35% (12/34) received combination and monotherapy, respectively. Patients managed with combination therapy had comparable rates of prosthetic valve endocarditis (41% vs 17%, P=0.25), a vegetation size > 1cm (59% vs 42%, P=0.33) and no receipt of cardiac surgical intervention despite an indication (32% vs 17%, P=0.44) compared to those who received monotherapy. There was no significant difference in 42-day failure rates (32% vs 17%, P=0.44), 90-day mortality (18% vs 25%, P=0.68) or median hospital length of stay (22 days vs. 23, P=0.914) between patients who receivedcombination therapy and monotherapy. Patients who experienced 42-day failure were more likely to have multi-drug resistant (MDR) Pseudomonas on initial blood cultures (44% vs 4%, P=0.012) and were less likely to be initially managed with piperacillin/tazobactam or cefepime (44% vs 96%, P=0.004) compared to those who experienced clinical cure. Combination therapy versus monotherapy Factors associated with clinical failure Conclusion To our knowledge, this is the largest study of Pseudomonas endocarditis to date. We did Not identify a benefit to combination therapy; however, the overall sample size was small. Endocarditis due to MDR P. aeruginosa was associated with a higher risk of clinical failure. Disclosures Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofad500.2030

Authors: Sunish Shah, Lloyd Clarke, Ryan K Shields

Institutions: UPMC Presbyterian, University of Pittsburgh Medical Center, University of Pittsburgh

Language: English

Topic: Infective Endocarditis Diagnosis and Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,676