{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T01:16:16Z","timestamp":1748049376136,"version":"3.40.5"},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Nach der notfallm\u00e4\u00dfigen Vorstellung des Patienten aufgrund von persistierend febrilen Temperaturen zeigten sich positive Blutkulturen mit Enterococcus faecalis und eine Vegetation auf der Mitralklappe in der Echokardiografie. Die Diagnose einer E.-faecalis-Endokarditis wurde gestellt und eine entsprechende antimikrobielle Kombinationstherapie mit Amoxicillin und Gentamicin begonnen. Im Verlauf erfolgte die Umstellung von Gentamicin auf Ceftriaxon aufgrund einer akuten Nieren-Funktionseinschr\u00e4nkung gem\u00e4\u00df KDIGO-Stadium AKI 1. Es wurde zudem ein mechanischer Mitralklappen-Ersatz durchgef\u00fchrt. Nach einer fortlaufenden antimikrobiellen Therapie von 5 Wochen erfolgte eine notfallm\u00e4\u00dfige R\u00fcckverlegung aus der kardiologischen Rehabilitation aufgrund von akuten Flankenschmerzen mit Emesis.<\/jats:p><jats:p>Klinisch pr\u00e4sentierte sich der 64-j\u00e4hrige Patient mit Druckdolenz im rechten Abdomen. Laborchemisch zeigte sich eine akute Nierensch\u00e4digung AKI 3, bei Mikroh\u00e4maturie im Urinstatus. Sonografisch zeigte sich eine Stauung des rechten Nierenbecken-Kelchsystems. In der Abdomen-CT stellte sich ein Konkrement in der Harnblase dar.<\/jats:p><jats:p>Das 7\u00d73\u00d72mm gro\u00dfe Konkrement wurde durch die Miktion ausgeschieden und bestand zu 100% aus Amoxicillin. Somit wurde die Diagnose einer Amoxicillin-Urolithiasis gestellt.<\/jats:p><jats:p>Die Dosierung von Amoxicillin wurde nierenadaptiert reduziert. Aufgrund eines initial unklaren Entz\u00fcndungszustands im Rahmen eines Dressler-Syndroms wurde die Kombinationstherapie nach 8 Wochen anstelle der geplanten 6 Wochen beendet. Zu diesem Zeitpunkt war der Kreatininwert noch leichtgradig erh\u00f6ht. Nach zwei Wochen lag dieser wieder im Normbereich. Zwei Jahre sp\u00e4ter ist der Patient ohne Rezidiv der Endokarditis.<\/jats:p><jats:p>Bei einer intrarenalen Ausf\u00e4llung von Kristallen kommt es zu einer Kristall-Nephropathie, was eine seltene Nebenwirkung von Amoxicillin darstellt. Wie in diesem Fall kann eine massive Ausf\u00e4llung von makroskopischen Kristallen im Nierenbecken sogar zu einer Urolithiasis mit einer obstruktiven Nephropathie f\u00fchren. Dieser Fall demonstriert die Wichtigkeit einer regelm\u00e4\u00dfigen \u00dcberpr\u00fcfung der Nierenfunktion bei einer Therapie mit Amoxicillin, insbesondere der hochdosierten Therapie mit langer Therapiedauer.<\/jats:p>","DOI":"10.1055\/a-2505-8860","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T22:48:47Z","timestamp":1746571727000},"page":"628-631","source":"Crossref","is-referenced-by-count":1,"title":["Seltene Nebenwirkung bei Therapie einer bakteriellen Endokarditis"],"prefix":"10.1055","volume":"150","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0553-3357","authenticated-orcid":false,"given":"Carola Andrea","family":"George","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Innere Medizin, Hirslanden Klinik Aarau, Aarau, Schweiz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Gisler","sequence":"additional","affiliation":[{"name":"Herzchirurgie Aarau, Hirslanden Klinik Aarau, Aarau, Schweiz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursula","family":"Fl\u00fcckiger","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Innere Medizin, Hirslanden Klinik Aarau, Aarau, Schweiz"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1093\/cid\/ciad271","article-title":"The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria","volume":"77","author":"V Fowler","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3948","DOI":"10.1714\/4144.41413","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"V Delgado","year":"2023","journal-title":"Eur Heart J"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1093\/cid\/ciac777","article-title":"Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse","volume":"76","author":"P Danneels","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1093\/cid\/cit052","article-title":"Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis","volume":"56","author":"N Fern\u00e1ndez-Hidalgo","year":"2013","journal-title":"Clin Infect Dis"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"e01630","DOI":"10.1128\/AAC.01630-17","article-title":"Dramatic Increase of Amoxicillin-Induced Crystal Nephropathy Found in a Cohort Study of French Pharmacovigilance Centers","volume":"62","author":"D Vodovar","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1007\/s40264-023-01316-1","article-title":"Nephrotoxicity of Amoxicillin and Third-Generation Cephalosporins: An Updated Review","volume":"46","author":"A Garnier","year":"2023","journal-title":"Drug Saf"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1093\/ndt\/18.1.212","article-title":"Amoxycillin, a rare but possible cause of crystalluria","volume":"18","author":"G Fogazzi","year":"2003","journal-title":"Nephrol Dia Transplant"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1093\/ndt\/gfab074","article-title":"Amoxicillin crystalluria is associated with acute kidney injury in patients treated for acute infective endocarditis","volume":"36","author":"M Jamme","year":"2021","journal-title":"Nephrol Dia Transplant"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s40265-017-0853-7","article-title":"Drug-Induced Kidney Stones and Crystalline Nephropathy: Pathophysiology, Prevention and Treatment","volume":"78","author":"M Daudon","year":"2018","journal-title":"Drugs"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101340","DOI":"10.1016\/j.eclinm.2022.101340","article-title":"Incidence, associated factors, and effect on renal function of amoxicillin crystalluria in patients receiving high doses of intravenous amoxicillin (The CRISTAMOX Study): A cohort study","volume":"45","author":"S Demotier","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1053\/j.ajkd.2023.09.017","article-title":"Toxic Nephropathies of the Tubulointerstitium: Core Curriculum 2024","volume":"83","author":"N Krishnan","year":"2024","journal-title":"Am J Kidney Dis"}],"container-title":["DMW - 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