{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T06:02:19Z","timestamp":1776060139364,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Subdirecci\u00f3n General de Redes y Centros de Investigaci\u00f3n Cooperativa"},{"name":"Ministerio de Ciencia"},{"name":"Innovaci\u00f3n y Universidades"},{"name":"Spanish Network for Research in Infectious Diseases"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Infective endocarditis (IE) caused by viridans and gallolyticus group streptococci (VGS-GGS) resistant to penicillin (PEN-R; minimum inhibitory concentration \u22654\u2005mg\/L) is rare but poses therapeutic challenges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To describe the characteristics of patients with IE caused by PEN-R VGS-GGS, focusing on antimicrobial management.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective analysis of a prospective cohort of definite IE caused by PEN-R VGS-GGS between 2008 and 2023 in 40 Spanish hospitals. We describe clinical characteristics, management and outcome of the cases, and compare them to IE caused by VGS-GGS with susceptibility or susceptibility with increased exposure to penicillin (PEN-I).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified nine cases of PEN-R VGS-GGS IE in a cohort of 1563 streptococcal IE (0.58%). All isolates belonged to S. mitis group. Three cases died during hospitalization and no relapse occurred at 3\u2005months of follow-up. Compared to cases with susceptibility or PEN-I, PEN-R showed a higher rate of mitral location (78% versus 51%), surgical indication (67% versus 51%), and in-hospital mortality (33% versus 12%). Most cases (86%) showed resistance to third-generation cephalosporins. The preferred antibiotic regimen was beta-lactam-based: ceftriaxone plus gentamicin, penicillin plus gentamicin, ceftriaxone plus levofloxacin, and ceftaroline plus daptomycin. Two cases received a combination of vancomycin plus gentamicin. Levofloxacin was used in two cases in combination with ceftriaxone or daptomycin. All patients that received cardiac surgery were cured at the end of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>IE caused by PEN-R VGS-GGS was rare and only affected mitis group streptococci. Antibiotic combination including a beta-lactam seems to be effective in its management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkae345","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T11:30:52Z","timestamp":1727782252000},"page":"3230-3235","source":"Crossref","is-referenced-by-count":3,"title":["Infective endocarditis caused by penicillin-resistant viridans group streptococci: a series of nine cases from a Spanish cohort"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3652-3121","authenticated-orcid":false,"given":"Francesc","family":"Escrihuela-Vidal","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d\u00b4Investigaci\u00f3 Biom\u00e8dica de Bellvitge), University of Barcelona , Barcelona 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Mara\u00f1\u00f3n, CIBER Enfermedades Respiratorias-CIBERES (CB06\/06\/0058), Facultad de Medicina, Universidad Complutense de Madrid , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3790-5754","authenticated-orcid":false,"given":"Miguel","family":"Villamar\u00edn","sequence":"additional","affiliation":[{"name":"Servei de Malalties Infeccioses, Hospital Universitari Vall d\u2019Hebron, Vall d\u2019Hebron Institut de Recerca (VHIR), Vall d\u2019Hebron Barcelona Campus Hospitalari, Passeig de la Vall d\u2019Hebron 119-129, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicol\u00e1s","family":"Jim\u00e9nez Garc\u00eda","sequence":"additional","affiliation":[{"name":"Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol , Marbella, M\u00e1laga 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