Partial oral treatment of infective endocarditis in real-world settings – an in-depth analysis of the prospectively evaluated German DERIVE cohort

Abstract

ObjectivesTo assess the efficacy and feasibility of partial oral treatment of infective endocarditis (IE) in a tertiary care real-world setting. MethodsData were gathered from two German tertiary care referral centers, Freiburg and Cologne, within the German Registry of Cardiovascular Infections (DERIVE). Patients were prospectively evaluated for at least 90 days post-IE onset through medical records, telephone interviews, and outpatient visits. Epidemiological, clinical and outcome parameters were recorded. Comparisons were done using descriptive statistics and the Kaplan-Meier estimator. A landmark analysis was used for mortality, IE-related mortality and IE-related complications. ResultsAmong 418 patients with definite or possible IE, a total of 178 patients were included due to guideline-adherent (i.e. 2015 Infectious Diseases Society of America (IDSA) guidelines) intravenous treatment in the early critical phase. Of these, 148 patients completed a course of intravenous treatment (IV), and 30 patients were switched to partial oral treatment (POT). Perivalvular complications, septic shock and vegetations > 4 mm were more frequent in the IV group, while disseminated disease at onset was higher in the POT group. Causative pathogens were similarly distributed between groups with S. aureus (IV 52/148 (35 %); POT 10/30 (33 %)) and Streptococcus spp. (IV 48/148 (32 %); POT 10/30 (33 %)) being the dominant pathogens.During follow-up, 61/148 (41 %) patients in the IV group and 5/30 (17 %) in the POT group died, with almost no new complications after POT switch. ConclusionsWe provide prospectively collected real-world evidence supporting the feasibility and safety of POT for IE, emphasizing the importance of careful patient selection. The findings encourage a nuanced approach to IE management, suggesting that POT is a viable treatment alternative.