Nuria Vallejo Camazon1,2, Lourdes Mateu3, Germán Cediel4, Laura Escolà-Vergé5, Nuria Fernández-Hidalgo5, Mercedes Gurgui Ferrer6, Maria Teresa Perez Rodriguez7, Guillermo Cuervo8, Raquel Nuñez Aragón9, Cinta Llibre4, Nieves Sopena3, Maria Dolores Quesada10, Elisabeth Berastegui4, Albert Teis4, Jorge Lopez Ayerbe4, Gladys Juncà4, Francisco Gual4, Elena Ferrer Sistach4, Ainhoa Vivero9, Esteban Reynaga3, Maria Hernández Pérez11, Christian Muñoz Guijosa4, Lluisa Pedro-Botet12,3, Antoni Bayés-Genís4,12. 1. Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. nvallejo73@hotmail.com. 2. Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain. nvallejo73@hotmail.com. 3. Unitat Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 4. Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 5. Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 6. Unitat de Malalties Infeccioses, Hospital Santa Creu i Sant Pau,Universitat Autonoma de Barcelona, Barcelona, Spain. 7. Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario de Vigo, Vigo, Spain. 8. Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. 9. Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 10. Microbiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 11. Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 12. Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: To date, there is little information regarding management of patients with infective endocarditis (IE) that did not undergo an indicated surgery. Therefore, we aimed to evaluate prognosis of these patients treated with a long-term antibiotic treatment strategy, including oral long term suppressive antibiotic treatment in five referral centres with a multidisciplinary endocarditis team. METHODS: This retrospective, multicenter study retrieved individual patient-level data from five referral centres in Spain. Among a total of 1797, 32 consecutive patients with IE were examined (median age 72 years; 78% males) who had not undergone an indicated surgery, but received long-term antibiotic treatment (LTAT) and were followed by a multidisciplinary endocarditis team, between 2011 and 2019. Primary outcomes were infection relapse and mortality during follow-up. RESULTS: Among 32 patients, 21 had IE associated with prostheses. Of the latter, 8 had an ascending aorta prosthetic graft. In 24 patients, a switch to long-term oral suppressive antibiotic treatment (LOSAT) was considered. The median duration of LOSAT was 277 days. Four patients experienced a relapse during follow-up. One patient died within 60 days, and 12 patients died between 60 days and 3 years. However, only 4 deaths were related to IE. CONCLUSIONS: The present study results suggest that a LTAT strategy, including LOSAT, might be considered for patients with IE that cannot undergo an indicated surgery. After hospitalization, they should be followed by a multidisciplinary endocarditis team.
BACKGROUND: To date, there is little information regarding management of patients with infective endocarditis (IE) that did not undergo an indicated surgery. Therefore, we aimed to evaluate prognosis of these patients treated with a long-term antibiotic treatment strategy, including oral long term suppressive antibiotic treatment in five referral centres with a multidisciplinary endocarditis team. METHODS: This retrospective, multicenter study retrieved individual patient-level data from five referral centres in Spain. Among a total of 1797, 32 consecutive patients with IE were examined (median age 72 years; 78% males) who had not undergone an indicated surgery, but received long-term antibiotic treatment (LTAT) and were followed by a multidisciplinary endocarditis team, between 2011 and 2019. Primary outcomes were infection relapse and mortality during follow-up. RESULTS: Among 32 patients, 21 had IE associated with prostheses. Of the latter, 8 had an ascending aorta prosthetic graft. In 24 patients, a switch to long-term oral suppressive antibiotic treatment (LOSAT) was considered. The median duration of LOSAT was 277 days. Four patients experienced a relapse during follow-up. One patient died within 60 days, and 12 patients died between 60 days and 3 years. However, only 4 deaths were related to IE. CONCLUSIONS: The present study results suggest that a LTAT strategy, including LOSAT, might be considered for patients with IE that cannot undergo an indicated surgery. After hospitalization, they should be followed by a multidisciplinary endocarditis team.
Entities:
Keywords:
infective endocarditis; suppressive antibiotic treatment; surgery
Authors: María N Pizzi; Albert Roque; Nuria Fernández-Hidalgo; Hug Cuéllar-Calabria; Ignacio Ferreira-González; María T Gonzàlez-Alujas; Gerard Oristrell; Laura Gracia-Sánchez; Juan J González; José Rodríguez-Palomares; Manuel Galiñanes; Olga Maisterra-Santos; David Garcia-Dorado; Joan Castell-Conesa; Benito Almirante; Santiago Aguadé-Bruix; Pilar Tornos Journal: Circulation Date: 2015-08-14 Impact factor: 29.690
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