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Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort.
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- Author(s): s, Juan M Pericà; Llopis, Jaume; González-Ramallo, Víctor; Goenaga, Miguel Á; Muñoz, Patricia; García-Leoni, M Eugenia; Fariñas, M Carmen; Pajarón, Marcos; Ambrosioni, Juan; Luque, Rafael; Goikoetxea, Josune; Oteo, José A; Carrizo, Enara; Bodro, Marta; Reguera-Iglesias, José M; Navas, Enrique; Hidalgo-Tenorio, Carmen; Miró, José M; investigators, Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES)
- Source:
Clinical Infectious Diseases; 11/15/2019, Vol. 69 Issue 10, p1690-1700, 11p- Subject Terms:
AORTIC valve surgery; DISEASE relapse; MORTALITY risk factors; ENDOCARDITIS; ANTIBIOTICS; CONFIDENCE intervals; HEALTH facilities; CARDIAC surgery; OUTPATIENT services in hospitals; INFECTIVE endocarditis; LONGITUDINAL method; MEDICAL cooperation; RESEARCH; RISK assessment; STAPHYLOCOCCUS; STAPHYLOCOCCUS aureus; TREATMENT effectiveness; RETROSPECTIVE studies; VIRIDANS strepotococci; TREATMENT duration; PATIENT readmissions; ODDS ratio; EVALUATION - Source:
- Additional Information
- Subject Terms:
- Abstract: Background Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008–2012) was performed. Results A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56–76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32–54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P <.001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04–1.42; P =.01) and cardiac surgery (OR, 0.24; 95% CI,.09–.63; P =.04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI,.22–.98; P =.007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Clinical Infectious Diseases is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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