Real-world Application of Oral Therapy for Infective Endocarditis: A Multicenter Retrospective, Cohort Study

Link to article at PubMed

Clin Infect Dis. 2023 Mar 7:ciad119. doi: 10.1093/cid/ciad119. Online ahead of print.


BACKGROUND: We sought to compare the outcomes of patients treated with intravenous (IV)-only vs. oral transitional antimicrobial therapy for infective endocarditis (IE) after implementing a new Expected Practice within The Los Angeles County Department of Health Services (LAC DHS).

METHODS: We conducted a multi-centered, retrospective cohort study of adults with definite or possible IE treated with IV-only vs. oral therapy at the three acute care, public hospitals in the LAC DHS system between December 2018 to June 2022. The primary outcome was clinical success at 90 days, defined as being alive, and without recurrence of bacteremia or treatment-emergent infectious complications.

RESULTS: We identified 257 patients with IE treated with IV-only (n=211) or oral transitional (n=46) therapy who met study inclusion criteria. Study arms were similar for many demographics; however, the IV cohort was older, and had more aortic valve involvement, hemodialysis patients, and central venous catheters present. In contrast, the oral cohort had a higher percentage of IE caused by methicillin-resistant S. aureus. There was no significant difference between the groups in clinical success at 90 days or last follow-up. There was no difference in recurrence of bacteremia or readmission rates. However, patients treated with oral therapy had significantly fewer adverse events. Multivariable regression adjustments did not find significant associations between any selected variables and clinical success across treatment groups.

CONCLUSIONS: These results demonstrate similar outcomes of real-world use of oral vs. IV-only therapy for IE, in accord with prior randomized controlled trials and meta-analyses.

PMID:36881940 | DOI:10.1093/cid/ciad119

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