Key result
Pre-surgery antibiotics >14 days linked to 39% vs 95% valve culture positivity in enterococcal endocarditis.
Why the study?
Heart valve culture results provide insights into the antibiotic treatment duration required to achieve valve sterilisation, motivating an assessment of culture positivity rates in resected valves from patients with Enterococcus faecalis infective endocarditis.
Does the duration of pre-surgery antibiotic therapy (>14 days vs ≤14 days) or the choice of synergistic antibiotic (ceftriaxone vs gentamicin) affect heart valve culture positivity rates in adults with Enterococcus faecalis infective endocarditis undergoing valve surgery?
Cohort (n=109)
Yes
Does the duration of pre-surgery antibiotic therapy (>14 days vs ≤14 days) or the choice of synergistic antibiotic (ceftriaxone vs gentamicin) affect heart valve culture positivity rates in adults with Enterococcus faecalis infective endocarditis undergoing valve surgery?
Patients with Enterococcus faecalis infective endocarditis undergoing valve surgery have a high rate of persistent valve culture positivity (39%) even after more than 14 days of antibiotic therapy, with equivalent sterilisation rates between ceftriaxone and gentamicin synergistic regimens.
Answers are grounded in this paper and cite their sources.
Valve positivity was associated with shorter preoperative antibiotics but not regimen; hypothesis-generating for surgical timing in E. faecalis endocarditis.
Purpose Heart valve culture results from patients with infective endocarditis (IE) provide insights into the antibiotic treatment duration required to achieve valve sterilisation. We aimed to assess the valve culture positivity rates of valves resected from patients with Enterococcus faecalis IE (EFIE). Methods This was a national retrospective observational cohort study assessing adults with EFIE receiving valve surgery from 2004 to 2023 in Aotearoa New Zealand. We compared the valve culture result with the antibiotic treatment regimen and duration received before surgery. Results One hundred and nine patients with EFIE met inclusion criteria. The valve culture positivity rate was 95% and 39% for valve samples obtained within 14 days or after 14 days of antibiotic treatment respectively. In addition to amoxicillin and/or benzylpenicillin, 40 patients received ceftriaxone and 38 received gentamicin as the sole pre-surgery synergistic antibiotic. There was no difference in valve culture positivity rates comparing the ceftriaxone and gentamicin synergistic antibiotic groups (P = 0.49). Conclusion Patients with EFIE who received valve surgery within 14 days of commencing antibiotic treatment had a very high valve culture positivity rate and this rate continued at moderate levels for those who received surgery after 14 days. We observed no difference in valve culture positivity rates when ceftriaxone or gentamicin was used as the sole pre-surgery synergistic antibiotic. The valve samples that remained culture positive after prolonged antibiotic treatment may help explain the higher relapse rate of patients with EFIE who do not receive valve surgery when compared with patients with other causes of IE.
No takes yet. Share an insight, caveat, or question.
Briggs et al. (2026) conducted a cohort in Enterococcus faecalis infective endocarditis (n=109). Pre-surgery antibiotic treatment duration (>14 days) and synergistic regimen (ceftriaxone) vs. Pre-surgery antibiotic duration (≤14 days) and gentamicin synergistic regimen was evaluated on Resected heart valve culture positivity rate (p=0.49). Pre-surgery antibiotic duration >14 days yielded 39% valve culture positivity vs 95% for ≤14 days in E. faecalis endocarditis, with no difference between ceftriaxone and gentamicin (P=0.49).
Synapse has enriched 10 related papers. Consider them for comparative context: