1981. Alternatives to guideline directed therapy in bacterial endocarditis

Abstract

Abstract Background Existing society guidelines recommend therapy with intravenous antibiotics for 4-6 weeks for most cases of endocarditis. Recent literature has demonstrated that partial oral antibiotic treatment is non-inferior to intravenous therapy and that partial treatment with dalbavancin or shorter durations of therapy in patients undergoing valve surgery can also lead to positive clinical outcomes. However, there is not currently a standardized approach to how these alternative treatments should be utilized. Methods A standardized protocol for use of shortened duration of antibiotic treatment post-operatively, oral antibiotic therapy, and dalbavancin was developed by the endocarditis consult service in conjunction with the University of Kentucky multidisciplinary endocarditis team. Subsequently, consecutive patients with endocarditis treated with these alternative therapies were identified and reviewed by study investigators. The primary outcomes were 90-day mortality, 30-day readmission, relapsed infection, and completion of therapy. Results Between September 7th, 2021 and April 15th, 2022 we identified 20 cases of endocarditis managed with one of the alternative treatment regimens. Fourteen patients had recent injection drug use. Twelve patients were initially treated with partial oral therapy. Five patients were initially treated with dalbavancin. Three patients received two-week courses of intravenous antibiotics after valve surgery. For all patients, 90-day mortality was 0% and 30-day readmission rate was 10%. Ten patients completed oral treatment. Three patients completed therapy with Dalbavancin with two patients transitioning to the oral group due to side effects. All three patients with shortened durations of therapy completed treatment. One patient treated with dalbavancin with crossover to oral therapy developed relapsed bacteremia with the same organism after self-discontinuing a suppressive oral antibiotic. Conclusion A systematic approach involving a multidisciplinary team can allow for successful utilization of alternative approaches to guideline directed treatment for endocarditis with high rates of therapy completion, low rates of mortality, re-admission, and relapsed infection, including in persons who inject drugs. Disclosures All Authors: No reported disclosures.