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Antimicrobial Agents and Chemotherapy, October 2009, p. 4305-4310, Vol. 53, No. 10
0066-4804/09/$08.00+0     doi:10.1128/AAC.00444-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Pilot Study of Ampicillin-Ceftriaxone Combination for Treatment of Orthopedic Infections Due to Enterococcus faecalis{triangledown}

G. Euba,1* J. Lora-Tamayo,1 O. Murillo,1 S. Pedrero,2 J. Cabo,2 R. Verdaguer,3 and J. Ariza1

Infectious Diseases Department,1 Orthopedic Surgery Department,2 Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain3

Received 2 April 2009/ Returned for modification 5 June 2009/ Accepted 31 July 2009

Serious Enterococcus faecalis infections usually require combination therapy to achieve a bactericidal effect. In orthopedic infections, the prognosis of enterococcal etiology is considered poor, and the use of aminoglycosides is questioned. The ampicillin-ceftriaxone combination has recently been accepted as alternative therapy for enterococcal endocarditis. After one of our patients with endocarditis and vertebral osteomyelitis was cured with ampicillin-ceftriaxone, we started a pilot study of orthopedic infections. Patients with infections due to E. faecalis (with two or more surgical samples or blood cultures) diagnosed during 2005 to 2008 were recruited. Polymicrobial infections with ampicillin- and ceftriaxone-resistant microorganisms were excluded. Patients received ampicillin (8 to 16 g/day)-ceftriaxone (2 to 4 g/day) and were followed up prospectively. Of 31 patients with E. faecalis infections, 10 received ampicillin-ceftriaxone. Including the first patient, 11 patients were treated with ampicillin-ceftriaxone: 3 with prosthetic joint infections, 3 with instrumented spine arthrodesis device infections, 2 with osteosynthesis device infections, 1 with foot osteomyelitis, and 2 with vertebral osteomyelitis and endocarditis. Six infections (55%) were polymicrobial. All cases except the vertebral osteomyelitis ones required surgery, with retention of foreign material in six cases. Ampicillin-ceftriaxone was given for 25 days (interquartile range, 15 to 34 days), followed by amoxicillin (amoxicilline) being given to seven patients (64%). One patient with endocarditis died within 2 weeks (hemorrhagic stroke) and was not evaluable. For one patient with prosthesis retention, the infection persisted; 9/10 patients (90%) were cured, but 1 patient was superinfected. Follow-up was for 21 months (interquartile range, 14 to 36 months). Ampicillin-ceftriaxone may be a reasonable synergistic combination to treat orthopedic infections due to E. faecalis. Our experience, though limited, shows good outcomes and tolerability and may provide a basis for further well-designed comparative studies.

* Corresponding author. Mailing address: Infectious Diseases Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. Phone: 34 93 260 7625. Fax: 34 93 260 7637. E-mail: goranee{at}bellvitgehospital.cat

{triangledown} Published ahead of print on 10 August 2009.

Antimicrobial Agents and Chemotherapy, October 2009, p. 4305-4310, Vol. 53, No. 10
0066-4804/09/$08.00+0     doi:10.1128/AAC.00444-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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