Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study.

Adult Humans Retrospective Studies Cohort Studies Methicillin-Resistant Staphylococcus aureus Endocarditis, Bacterial / drug therapy Endocarditis / drug therapy Bacteremia / drug therapy Anti-Bacterial Agents / therapeutic use Staphylococcal Infections / drug therapy
infective endocarditis oral stepdown antibiotic therapy

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
11 09 2023
Historique:
received: 05 01 2023
medline: 13 9 2023
pubmed: 8 3 2023
entrez: 7 3 2023
Statut: ppublish

Résumé

We sought to compare the outcomes of patients treated with intravenous (IV)-only vs oral transitional antimicrobial therapy for infective endocarditis (IE) after implementing a new expected practice within the Los Angeles County Department of Health Services (LAC DHS). We conducted a multicentered, retrospective cohort study of adults with definite or possible IE treated with IV-only vs oral therapy at the 3 acute care public hospitals in the LAC DHS system between December 2018 and June 2022. The primary outcome was clinical success at 90 days, defined as being alive and without recurrence of bacteremia or treatment-emergent infectious complications. We identified 257 patients with IE treated with IV-only (n = 211) or oral transitional (n = 46) therapy who met study inclusion criteria. Study arms were similar for many demographics; however, the IV cohort was older, had more aortic valve involvement, were hemodialysis patients, and had central venous catheters present. In contrast, the oral cohort had a higher percentage of IE caused by methicillin-resistant Staphylococcus aureus. There was no significant difference between the groups in clinical success at 90 days or last follow-up. There was no difference in recurrence of bacteremia or readmission rates. However, patients treated with oral therapy had significantly fewer adverse events. Multivariable regression adjustments did not find significant associations between any selected variables and clinical success across treatment groups. These results demonstrate similar outcomes of real-world use of oral vs IV-only therapy for IE, in accord with prior randomized, controlled trials and meta-analyses.

Sections du résumé

BACKGROUND
We sought to compare the outcomes of patients treated with intravenous (IV)-only vs oral transitional antimicrobial therapy for infective endocarditis (IE) after implementing a new expected practice within the Los Angeles County Department of Health Services (LAC DHS).
METHODS
We conducted a multicentered, retrospective cohort study of adults with definite or possible IE treated with IV-only vs oral therapy at the 3 acute care public hospitals in the LAC DHS system between December 2018 and June 2022. The primary outcome was clinical success at 90 days, defined as being alive and without recurrence of bacteremia or treatment-emergent infectious complications.
RESULTS
We identified 257 patients with IE treated with IV-only (n = 211) or oral transitional (n = 46) therapy who met study inclusion criteria. Study arms were similar for many demographics; however, the IV cohort was older, had more aortic valve involvement, were hemodialysis patients, and had central venous catheters present. In contrast, the oral cohort had a higher percentage of IE caused by methicillin-resistant Staphylococcus aureus. There was no significant difference between the groups in clinical success at 90 days or last follow-up. There was no difference in recurrence of bacteremia or readmission rates. However, patients treated with oral therapy had significantly fewer adverse events. Multivariable regression adjustments did not find significant associations between any selected variables and clinical success across treatment groups.
CONCLUSIONS
These results demonstrate similar outcomes of real-world use of oral vs IV-only therapy for IE, in accord with prior randomized, controlled trials and meta-analyses.

Identifiants

DOI: 10.1093/cid/ciad119 PMID: 36881940
pubmed: 36881940
pii: 7071558
doi: 10.1093/cid/ciad119
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

672-679

Commentaires et corrections

Type : CommentIn

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Déclaration de conflit d'intérêts

Potential conflicts of interests. N. W. D. reports receipt of a speaker’s fee for IDWeek 2022, funded by a collaboration of societies that help fund IDWeek, including Infectious Diseases Society of America, The Society of Healthcare Epidemiology of America, HIV Medicine Association, Pediatric Infectious Diseases Society, and Society of Infectious Diseases Pharmacists. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Auteurs

Sarah Freling (S)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.

Noah Wald-Dickler (N)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.
ORCID: 0000-0001-8782-5395

Josh Banerjee (J)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Catherine P Canamar (CP)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Soodtida Tangpraphaphorn (S)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Dara Bruce (D)

Department of Integrative Anatomical Sciences, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.

Kusha Davar (K)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
ORCID: 0000-0002-5153-2264

Fernando Dominguez (F)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Daniel Norwitz (D)

Department of Integrative Anatomical Sciences, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.

Ganesh Krishnamurthi (G)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.

Lilian Fung (L)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.

Ashley Guanzon (A)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Pharmacy, University of Southern California Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, USA.

Emi Minejima (E)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Pharmacy, University of Southern California Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, USA.

Michael Spellberg (M)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Catherine Spellberg (C)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Rachel Baden (R)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

Paul Holtom (P)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA.

Brad Spellberg (B)

Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Bactéries › Bactéries à Gram positif › Cocci à Gram positif › Staphylococcaceae › Staphylococcus › Staphylococcus aureus › Staphylococcus aureus résistant à la méticilline › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Endocardite › Endocardite bactérienne › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Endocardite › Real-World Application of Oral Therapy for...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Inflammation › Sepsie › Bactériémie › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Real-World Application of Oral Therapy for...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Infections bactériennes à Gram positif › Infections à staphylocoques › Real-World Application of Oral Therapy for...