Outpatient antimicrobial therapy for infective endocarditis. Single-centre experience

Abstract number: p1841

Cervera  C., Del Río  A., García  L., Sala  M., Olivera  A., Almela  M., Moreno  A., Mestres  C., Marco  F., Miró  J.M.

Objectives: 

To evaluate the characteristics and outcome of infective endocarditis (IE) patients included in a Outpatient antimicrobial therapy (OPAT) program.

Methods: 

From January 1997 to May 2005 all patients who received OPAT therapy for an IE were prospectively evaluated. Inclusion in OPAT program require clinical stability and agreement of patients. Active drug addiction was contraindicated for inclusion. Antibiotic treatment was administered in bolus for once-daily antibiotics regimens. We used CADD-Legacy™ PLUS (Deltec, Inc. St Paul. USA) portable infusion system for either continuous or intermittent-programmed bolus infusion.

Results: 

We included 65 patients, 51 male (78%), mean age 60 years old (SD: 19.3 years). The diagnostic of IE was definite in 45 cases (13 with pathologic diagnosis), 15 probable and 5 possible. Mostly of the cases were community-acquired IE (83%). Mitral valve IE was the most frequent anatomical site involved (46%), followed by aortic (32%). Native-valve IE represent the majority of cases (55%), but 32% were prosthetic-valve and 12% were pacemaker lead IE. Viridans group streptococci was the most frequent isolate (31 patients, 48%) with 4 cases of S. bovis IE. Eleven patients had S. aureus IE (17%). At the time of the diagnosis, 10 patients had valve rupture and 4 patients had periannular abscess. A total of 15 patients required some surgical intervention for the IE [9 valvular replacement (2 of them associated with aortic graft), 5 pacemaker extraction and 1 aortic graft]. The majority of the patients received outpatient monotherapy (65%). The most frequent antibiotic used was Ceftriaxone (55% of the cases), followed by cloxacillin 20%, gentamycin 20%, vancomycin 14%, teicoplanin 14%, ampicillin 8% and other antibiotics in 14%. In 60% of the patients the vascular access was a periferically-inserted venous central catheter and in 26% we used a portable infusion system. Twelve patients (18%) had some complication during OPAT that require hospital readmission, of which 5 could return to OPAT program. Three patients had a fatal outcome (deaths) during admission, not related to IE complications. The mean duration of OPAT was 18.9 days per patient, and globally supposed 1.230 days of hospital admission savings.

Conclusion: 

OPAT for IE can be a good therapeutic option for IE stable patients. This procedure can represent a considerable amount of hospital admissions savings, improving also patients' well-being, and must be take into account for the treatment of this disease.