Abstract
BackgroundAccording to the current guidelines of the European Society of Cardiology, patients with left-sided infective endocarditis are treated with intravenous antibiotics for 4–6 weeks, leading to extensive hospital stay and high costs. Recently, the Partial Oral Treatment of Endocarditis (POET) trial suggested that partial oral treatment is effective and safe in selected patients. Here, we investigated if such patients are seen in our daily clinical practice.MethodsWe enrolled 119 adult patients diagnosed with left-sided infective endocarditis in a retrospective, observational study. We identified those that would be eligible for switching to partial oral antibiotic treatment as defined in the POET trial (e.g. stable clinical condition without signs of infection). Secondary objectives were to provide insight into the time until each patient was eligible for partial oral treatment, and to determine parameters of longer hospital stay and/or need for extended intravenous antibiotic treatment.ResultsApplying the POET selection criteria, the condition of 38 patients (32%) was stable enough to switch them to partial oral treatment, of which 18 (47.3%), 8 (21.1%), 9 (23.7%) and 3 patients (7.9%) were eligible for switching after 10, 14, 21 days or 28 days of intravenous treatment, respectively.ConclusionOne-third of patients who presented with left-sided endocarditis in routine clinical practice were possible candidates for switching to partial oral treatment. This could have major implications for both the patient’s quality of life and healthcare costs. These results offer an interesting perspective for implementation of such a strategy, which should be accompanied by a prospective cost-effectiveness analysis.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01490-2) contains supplementary material, which is available to authorized users.
Highlights
All patients with left-sided infective endocarditis are treated with intravenous antibiotics for 4–6 weeks, according to the guidelines of the European Society of Cardiology [1,2,3]
Iversen et al conducted a randomised controlled trial, the Partial Oral Treatment of Endocarditis (POET) trial, and reported that partial oral antibiotic treatment is non-inferior to intravenous therapy in patients in stable clinical condition [4]. Based on these promising results, we retrospectively evaluated patients diagnosed with left-sided infective endocarditis who presented to the University Medical Center Utrecht from 1 January 2016 until 1 December 2018
Observational study, we reviewed the patient files of 119 consecutive adult patients with infective endocarditis that were discussed in the multidisciplinary endocarditis team; they received inpatient treatment at the University Medical Center Utrecht, the Netherlands and fulfilled the Duke criteria from 1 January 2016 until 1 December 2018
Summary
All patients with left-sided infective endocarditis are treated with intravenous antibiotics for 4–6 weeks, according to the guidelines of the European Society of Cardiology [1,2,3]. Adequate management of this fatal disease, with an in-hospital mortality rate of 15–40% [2,3,4,5,6,7], comprises early diagnosis with early initiation of intravenous bacteria-specific antibiotic treatment and surgical intervention if needed. According to the current guidelines of the European Society of Cardiology, patients with leftsided infective endocarditis are treated with intravenous antibiotics for 4–6 weeks, leading to extensive hospital stay and high costs.
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