Key result
Rifampin treatment was not associated with a significant difference in 1-year mortality compared to no rifampin in patients with staphylococcal prosthetic valve endocarditis (37.6% vs 31.6%; P=0.62).
Why the study?
Guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis, but robust clinical data supporting this are lacking and tolerability is an issue.
Does rifampin improve 1-year mortality in adults with staphylococcal prosthetic valve endocarditis?
Cohort (n=180)
Yes
Does rifampin improve 1-year mortality in adults with staphylococcal prosthetic valve endocarditis?
In patients with staphylococcal prosthetic valve endocarditis, the use of rifampin was not associated with improved 1-year survival or reduced relapse rates, challenging current international guideline recommendations.
Answers are grounded in this paper and cite their sources.
Rifampin addition may not improve staphylococcal PVE outcomes; leaves open guideline recommendations pending prospective trials.
BACKGROUND: International guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis (PVE). However, no robust clinical data support this recommendation, and rifampin tolerability is an issue. We aimed to evaluate the impact of rifampin for the treatment of staphylococcal PVE. METHODS: An observational retrospective cohort study of all adults with staphylococcal PVE (modified Duke criteria) was conducted in 3 referral centers for endocarditis, during years 2000-2018. Primary outcome measurement was 1-year mortality. RESULTS: We enrolled 180 patients with PVE due to Staphylococcus aureus (n = 114, 63.3%), or coagulase-negative staphylococci (n = 66, 36.7%), on bioprosthesis (n = 111, 61.7%), mechanical valve (n = 67, 37.2%), or both (n = 2). There were 132 males (73.3%), and mean age was 70.4 ± 12.4 years. Valvular surgery was performed in 51/180 (28.3%) cases. Despite all isolates were susceptible to rifampin, only 101 (56.1%) were treated with rifampin, for a median duration of 33.0 days, whereas 79 (43.9%) received no rifampin. Baseline characteristics were similar in both groups. One-year mortality was, respectively, 37.6% (38/101), and 31.6% (25/79), in patients treated with, or without, rifampin (P = .62). Relapse rates were 5.9% (6/101), and 8.9% (7/79), P = .65. Patients treated with rifampin had longer hospital length-of-stay: 42.3 ± 18.6 vs 31.3 ± 14.0 days (P < .0001). On multivariate analysis, only cerebral emboli (odds ratio [OR] 2.95, 95% confidence interval [CI], 1.30-6.70, P = .009), definite endocarditis (OR 7.15, 95% CI, 1.47-34.77, P = .018), and methicillin-resistant S. aureus (OR 6.04, 95% CI, 1.34-27.26, P = .019), were associated with 1-year mortality. CONCLUSIONS: A large proportion (43.9%) of staphylococcal PVE received no rifampin. One-year survival and relapse rates were similar in patients treated with or without rifampin.
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Bot et al. (2020) conducted a cohort in Staphylococcal prosthetic valve endocarditis (n=180). Rifampin vs. No rifampin was evaluated on 1-year mortality (p=0.62). Rifampin treatment was not associated with a significant difference in 1-year mortality compared to no rifampin in patients with staphylococcal prosthetic valve endocarditis (37.6% vs 31.6%; P=0.62).
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