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Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients.
Clin Microbiol Infect. 2016 Apr 15;
Authors: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi JL
Abstract
Although many international guidelines exist for the management of infective endocarditis (IE), recommendations are lacking on the opportunity of switching antibiotics from intravenous to oral route during treatment. We present a cohort study of 426 cases of IE over a period of 13 years (2000-2012), including 369 cases of definite IE according to the Duke criteria. Predictors of mortality were identified using the Cox proportional hazard analysis. The median age at diagnosis was 64.5 years (range: 7-98 years). One hundred and six patients (25%) had healthcare-associated IE. Oral streptococci (n=99, 23%) and Staphylococcus aureus (n=81, 19 %) were the predominant microorganisms. Ninety-two patients (22%) died during follow-up. After an initial phase of IV antibiotherapy, 214 patients (50%) were switched to the oral route, 21 days after the diagnosis of IE (median, range: 0-70). Patients in the 'oral' group had fewer comorbidities and criteria of severity at inclusion and were less frequently infected by S. aureus. Oral antibiotics were: amoxicillin alone in 109 cases, or a combination therapy of clindamycin, fluoroquinolone, rifampicin and/or amoxicillin in 46 cases, according to the susceptibility of the microorganisms. In the multivariate analysis, oral switch was not associated with an increased risk of mortality. During follow-up, only two relapses and four reinfections were observed in the 'oral' group (compared to nine and eight in the 'IV' group, respectively). In this study, switching to oral administration was not associated with an increased risk of relapse or reinfection. These promising results need to be confirmed by prospective studies.
PMID: 27091094 [PubMed - as supplied by publisher]