-
Partial oral treatment is associated with favourable outcomes, low hospital mortality, a low reinfection rate and cost savings.
-
One-third of 119 patients with left-sided infective endocarditis were in a clinically stable condition and eligible for switching to partial oral treatment, according to the criteria of the previously published Partial Oral Treatment of Endocarditis trial.
-
Our study offers a perspective for implementation of this strategy, accompanied by a prospective cost-effectiveness analysis.
Introduction
Methods
Study design and population
Data collection and outcomes
Results
Variable | Patients (n = 119) |
---|---|
Age, years (mean ± SD) | 64.8 ± 13.1 |
Female gender | 31 (26.1) |
Comorbidity | |
– Diabetes | 20 (16.8) |
– COPD/asthma | 9 (7.6) |
– Renal failure | 7 (5.9) |
– Cancer | 29 (24.4) |
Infective endocarditis according to Duke criteria | |
– Possible | 25 (21.0) |
– Definite | 94 (79.0) |
Duke criteria | |
– Pathological criteria | 51 (42.9) |
– Major | |
a. Positive blood culture | 78 (65.5) |
b. Positive imaging | 102 (85.7) |
– Minor | |
a. Predisposition (HC or IV) | 52 (43.7) |
b. Fever | 79 (66.4) |
c. Vascular phenomena | 22 (18.5) |
d. Immunological phenomena | 4 (3.4) |
e. Microbiological evidence | 31 (26.1) |
Microorganisms | |
– Streptococcus | 43 (36.1) |
– Enterococcus faecalis | 17 (14.3) |
– Staphylococcus aureus | 25 (21.0) |
– Coagulase-negative staphylococci | 8 (6.7) |
Laboratory results at admission (mean ± SD) | |
– Hemoglobin, mmol/L | 7.1 ± 1.3 |
– CRP, mg/L | 122.7 ± 105 |
– Leukocytes, ×109/L | 15.5 ± 25.3 |
– Creatinine, µmol/L | 116.0 ± 90.2 |
Pre-existing device | |
– Prosthetic heart valve | 48 (40.3) |
– Pacemaker | 13 (10.9) |
– Other known valve disease | |
a. Bicuspid valve | 5 (4.2) |
b. Moderate or severe regurgitation | 50 (42.0) |
Cardiac involvement (left) | |
– Mitral valve | 38 (31.9) |
– Aortic valve | 47 (39.5) |
– Mitral and aortic valve | 15 (12.6) |
– Pacemaker endocarditis | 5 (4.2) |
– Vegetation size >9 mm | 28 (23.5) |
Surgery | 71 (59.7) |
– EuroSCORE II (mean ± SD) | 12.0 ± 13.9 |
Pacemaker lead extraction | 1 (0.8) |
Mortality | 31 (26.1) |
– <30 days after diagnosis | 14 (45.2) |
– <1 year after diagnosis | 17 (54.8) |
Mortality after surgery | 14 (19.7) |
– <30 days after surgery | 7 (50.0) |
– <1 year after surgery | 7 (50.0) |
Criterion | Patients (n = 38) |
---|---|
No fevera and CRP levels <25% of peak levelb (n) | 19 |
No fevera and CRP <20 mg/L and leukocytes <15 × 109/L (n) | 19 |
Days after starting intravenous treatment (n (%)) | |
– 10–13 days | 18 (47.3) |
– 14–20 days | 8 (21.1) |
– 21–27 days | 9 (23.7) |
– 28–33 days | 3 (7.9) |
Criterion | Patients (n = 14) |
---|---|
Endocarditis-related complications during treatment | |
– Severe MI (reoperation) | 1 |
– Infected knee prosthesis | 1 |
Complications after surgery | |
– Acute renal failure (CVVH) | 4 |
– Epileptic insult | 1 |
– Pneumonia/pneumothorax | 4 |
– SAB/mycotic aneurysm | 1 |
– Mediastinitis | 1 |
Other indication for hospitalization | |
– Continual bleeding/factor VIII deficiency | 1 |
– Epidural abscess | 1 |
– Unsafe swallowing function as result of CVA | 1 |
– Delirium | 4 |