Abstract 17647: Potential Candidates for Partial Oral Treatment in Patients With Endocarditis at a US Center

Abstract

Introduction: In the Danish POET trial, oral step-down antibiotic therapy was non-inferior to intravenous antibiotic therapy (IVAB) in stabilized patients with left-sided infective endocarditis (IE). It is unknown whether oral treatment for IE can be efficacious in the US population. Aim Identify patients with IE who may have been candidates for POET treatment in a US cohort and assess the reduction of IVAB days and differences in characteristics and outcomes compared to participants in the POET trial. Methods: Retrospective study of patients admitted with IE at a US single center in Jan 2021 - July 2022. Possible candidates for POET treatment were patients with left-sided IE and infection with S. aureus , E. faecalis , Streptococcus , or coagulase-negative staph (CoNS), who had reached stabilization of infection or were discharged. Primary outcome was a composite of all-cause mortality, relapse of bacteremia, embolism or unplanned cardiac surgery within 6 months. Results: Of 152 patients with IE, 90 (59%) were possible candidates for POET treatment. Median length of IVAB after stabilization was 33 days (IQR 24-37). Compared to POET-trial patients, POET candidates in the US cohort were younger (64 vs 70 years), more often had diabetes (30% vs 17%), cancer (30% vs 8%), intravenous substance use (8% vs 1%) or pacemakers (18% vs 9%) [Table]. Prevalence of S. aureus (35% vs 22%) and CoNS infections (23% and 6%) was higher; Streptococcus was less common (30% vs 49%). Primary outcome occurred in 25 patients (28%) compared to 42 patients (10%) in the POET-trial (p<0.001). Conclusions: More than half of patients admitted with IE were possible POET candidates, for whom 4 weeks of IVAB may have been converted to oral antibiotics. Candidates in the US cohort had more comorbidities and primary outcome was three times higher than in the POET trial. Prospective studies are needed for verification of POET treatment in higher-risk US IE patients.