Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort

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.

Enterococcus faecalis Endocarditis and Outpatient Treatment: A Systematic Review of Current Alternatives

“…To this end, little evidence was found to support optimal continuation treatment. In fact, outpatient treatment of these patients has been a matter of discussion, and there is no consensus regarding patient and treatment selection [ 9 ]. To the best of our knowledge, there is no previous work summarizing the current evidence related to E. faecalis IE treatment appropriate for outpatient care.…”

“…These patients experience an initial period which involves a high risk of complications, such as heart failure, perivalvular extension or systemic embolism. Then, patients should remain hospitalized during this period, usually for 10 to 21 days, according to the clinical condition and the infection characteristics [ 9 ]. Thereafter, the only reason for remaining hospitalized is to receive intravenous antibiotic therapy [ 10 , 11 ].…”

Risk of New Bloodstream Infections and Mortality Among People Who Inject Drugs With Infective Endocarditis

“…Although oral therapy has been shown to be effective for infective endocarditis in non-PWID, 7 concerns regarding adherence have limited this approach in PWID. Outpatient parenteral antimicrobial therapy (OPAT) is safe, efficacious, and cost-effective for treating many infections, 8 , 9 , 10 , 11 but PWID are generally not considered candidates. This decision is in part due to the risk of new bloodstream infections (BSIs) from ongoing intravenous drug use (IVDU), commonly through central venous catheters inserted for antimicrobial treatment.…”

Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study

“…One of the many downstream consequences of the opioid crisis has been a marked increase in the incidence and associated costs of hospitalizations for serious bacterial infections associated with injection drug use such as endocarditis, osteomyelitis, septic arthritis, and epidural abscesses [1][2][3][4][5][6]. Treatment of these infections usually requires a prolonged course of intravenous (IV) antibiotics, which can often be completed from home in patients without another indication for a rehabilitation stay [7][8][9][10][11]. However, because this treatment involves sustained IV access, clinicians may be reluctant to discharge patients with opioid use disorder (OUD) to home, and home infusion companies may be reluctant to provide home services [12,13].…”