Abstract
Background: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods: Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. Results: A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P <. 001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P =. 01) and cardiac surgery (OR, 0.24; 95% CI,. 09-.63; P =. 04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI,. 22-.98; P =. 007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions: OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
| Original language | American English |
|---|---|
| Pages (from-to) | 1690-1700 |
| Number of pages | 11 |
| Journal | Clinical Infectious Diseases |
| Volume | 69 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 15 Nov 2019 |
Keywords
- hospitalization
- infective endocarditis
- outcomes
- outpatient parenteral antibiotic treatment
- readmission
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In: Clinical Infectious Diseases, Vol. 69, No. 10, 15.11.2019, p. 1690-1700.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis
T2 - A Prospective Cohort Study from the GAMES Cohort
AU - Pericà S, Juan M.
AU - Llopis, Jaume
AU - González Ramallo, Víctor
AU - Goenaga, Miguel A.
AU - Muñoz, Patricia
AU - García-Leoni, M. Eugenia
AU - Fariñas, M. Carmen
AU - Pajarón, Marcos
AU - Ambrosioni, Juan
AU - Luque, Rafael
AU - Goikoetxea, Josune
AU - Oteo, José A.
AU - Carrizo, Enara
AU - Bodro, Marta
AU - Reguera-Iglesias, José M.
AU - Navas, Enrique
AU - Hidalgo Tenorio, Carmen
AU - Miró, José M.
AU - Fernández Sánchez, Fernando
AU - Noureddine, Mariam
AU - Rosas, Gabriel
AU - De La Torre Lima, Javier
AU - Blanco, Roberto
AU - Victoria Boado, María
AU - Campaña Lázaro, Marta
AU - Crespo, Alejandro
AU - Goikoetxea, Josune
AU - Ramón Iruretagoyena, José
AU - Irurzun Zuazabal, Josu
AU - López-Soria, Leire
AU - Montejo, Miguel
AU - Nieto, Javier
AU - Rodrigo, David
AU - Rodríguez, Regino
AU - Vitoria, Yolanda
AU - Voces, Roberto
AU - Ma, María
AU - García López, Victoria
AU - Ivanova Georgieva, Radka
AU - Ojeda, Guillermo
AU - Rodríguez Bailón, Isabel
AU - Ruiz Morales, Josefa
AU - María Cuende, Ana
AU - Echeverría, Tomás
AU - Fuerte, Ana
AU - Gaminde, Eduardo
AU - Ángel Goenaga, Miguel
AU - Idígoras, Pedro
AU - Antonio Iribarren, José
AU - Izaguirre Yarza, Alberto
AU - Kortajarena Urkola, Xabier
AU - Reviejo, Carlos
AU - Carrasco, Rafael
AU - Climent, Vicente
AU - Llamas, Patricio
AU - Merino, Esperanza
AU - Plazas, Joaquín
AU - Reus, Sergio
AU - Álvarez, Nemesio
AU - María Bravo-Ferrer, José
AU - Castelo, Laura
AU - Cuenca, José
AU - Llinares, Pedro
AU - Miguez Rey, Enrique
AU - Rodríguez Mayo, María
AU - Sánchez, Efrén
AU - Sousa Regueiro, Dolores
AU - Javier Martínez, Francisco
AU - Del Mar Alonso, Ma
AU - Castro, Beatriz
AU - García Rosado, Dácil
AU - Del Carmen Durán, Ma
AU - Antonia Miguel Gómez, Ma
AU - Lacalzada, Juan
AU - Nassar, Ibrahim
AU - Plata Ciezar, Antonio
AU - Ma Reguera Iglesias, José
AU - Asensi Álvarez, Víctor
AU - Costas, Carlos
AU - De La Hera, Jesús
AU - Fernández Suárez, Jonnathan
AU - Iglesias Fraile, Lisardo
AU - León Arguero, Víctor
AU - López Menéndez, José
AU - Mencia Bajo, Pilar
AU - Morales, Carlos
AU - Moreno Torrico, Alfonso
AU - Palomo, Carmen
AU - Paya Martínez, Begoña
AU - Rodríguez Esteban, Ángeles
AU - Rodríguez García, Raquel
AU - Telenti Asensio, Mauricio
AU - Almela, Manuel
AU - Ambrosioni, Juan
AU - Azqueta, Manuel
AU - Brunet, Mercè
AU - Bodro, Marta
AU - Cartañá, Ramón
AU - Falces, Carlos
AU - Fita, Guillermina
AU - Fuster, David
AU - García De La Mària, Cristina
AU - García-Valls, Laura
AU - Hernández-Meneses, Marta
AU - Llopis Pérez, Jaume
AU - Marco, Francesc
AU - Miró, José M.
AU - Moreno, Asunción
AU - Nicolás, David
AU - Ninot, Salvador
AU - Quintana, Eduardo
AU - Paré, Carlos
AU - Pereda, Daniel
AU - Pericás, Juan M.
AU - Pomar, José L.
AU - Ramírez, José
AU - Rovira, Irene
AU - Sandoval, Elena
AU - Sala, Marta
AU - Sitges, Marta
AU - Soy, Dolors
AU - Téllez, Adrián
AU - Tolosana, José M.
AU - Vidal, Bárbara
AU - Vila, Jordi
AU - Adán, Iván
AU - Bermejo, Javier
AU - Bouza, Emilio
AU - Celemín, Daniel
AU - Cuerpo Caballero, Gregorio
AU - Delgado Montero, Antonia
AU - Fernández Cruz, Ana
AU - García Mansilla, Ana
AU - Eugenia García Leoni, Ma
AU - González Ramallo, Víctor
AU - Kestler Hernández, Martha
AU - Mari Hualde, Amaia
AU - Marín, Mercedes
AU - Martínez-Sellés, Manuel
AU - Cruz Menárguez, Ma
AU - Muñoz, Patricia
AU - Rincón, Cristina
AU - Rodríguez-Abella, Hugo
AU - Rodríguez-Créixems, Marta
AU - Pinilla, Blanca
AU - Pinto, Ángel
AU - Valerio, Maricela
AU - Vázquez, Pilar
AU - Verde Moreno, Eduardo
AU - Antorrena, Isabel
AU - Loeches, Belén
AU - Martín Quirós, Alejandro
AU - Moreno, Mar
AU - Ramírez, Ulises
AU - Rial Bastón, Verónica
AU - Romero, María
AU - Saldaña, Araceli
AU - Agüero Balbín, Jesús
AU - Armiñanzas Castillo, Carlos
AU - Arnaiz, Ana
AU - Arnaiz De Las Revillas, Francisco
AU - Cobo Belaustegui, Manuel
AU - Carmen Fariñas, María
AU - Fariñas-Álvarez, Concepción
AU - Gómez Izquierdo, Rubén
AU - García, Iván
AU - González Rico, Claudia
AU - Gutiérrez-Cuadra, Manuel
AU - Gutiérrez DÍez, José
AU - Pajarón, Marcos
AU - Antonio Parra, José
AU - Teira, Ramón
AU - Zarauza, Jesús
AU - Domínguez, Fernando
AU - García Pavía, Pablo
AU - González, Jesús
AU - Orden, Beatriz
AU - Ramos, Antonio
AU - Centella, Tomasa
AU - Manuel Hermida, José
AU - Luis Moya, José
AU - Martín-Dávila, Pilar
AU - Navas, Enrique
AU - Oliva, Enrique
AU - Del Río, Alejandro
AU - Rodríguez-Roda Stuart, Jorge
AU - Ruiz Rodríguez, Soledad
AU - Hidalgo Tenorio, Carmen
AU - Almendro Delia, Manuel
AU - Araji, Omar
AU - Miguel Barquero, José
AU - Calvo Jambrina, Román
AU - De Cueto, Marina
AU - Gálvez Acebal, Juan
AU - Méndez, Irene
AU - Morales, Isabel
AU - Eduardo López-Cortés, Luis
AU - De Alarcón, Arístides
AU - García, Emilio
AU - Luis Haro, Juan
AU - Antonio Lepe, José
AU - López, Francisco
AU - Luque, Rafael
AU - Javier Alonso, Luis
AU - Azcárate, Pedro
AU - Manuel Azcona Gutiérrez, José
AU - Ramón Blanco, José
AU - García-Álvarez, Lara
AU - Antonio Oteo, José
AU - Sanz, Mercedes
AU - De Benito, Natividad
AU - Gurguí, Mercé
AU - Pacho, Cristina
AU - Pericas, Roser
AU - Pons, Guillem
AU - Álvarez, M.
AU - Fernández, A. L.
AU - Martínez, Amparo
AU - Prieto, A.
AU - Regueiro, Benito
AU - Tijeira, E.
AU - Vega, Marino
AU - Canut Blasco, Andrés
AU - Cordo Mollar, José
AU - Carlos Gainzarain Arana, Juan
AU - García Uriarte, Oscar
AU - Martín López, Alejandro
AU - Ortiz De Zárate, Zuriñe
AU - Antonio Urturi Matos, José
AU - García Domínguez, Gloria
AU - Sánchez-Porto, Antonio
AU - Ma Arribas Leal, José
AU - García Vázquez, Elisa
AU - Hernández Torres, Alicia
AU - Blázquez, Ana
AU - De La Morena Valenzuela, Gonzalo
AU - Alonso, Ángel
AU - Aramburu, Javier
AU - Elena Calvo, Felicitas
AU - Moreno Rodríguez, Anai
AU - Tarabini-Castellani, Paola
AU - Heredero Gálvez, Eva
AU - Maicas Bellido, Carolina
AU - Largo Pau, José
AU - Antonia Sepúlveda, Ma
AU - Toledano Sierra, Pilar
AU - Zafar Iqbal-Mirza, Sadaf
AU - Cascales Alcolea, Eva
AU - Egea Serrano, Pilar
AU - Joaquín Hernández Roca, José
AU - Keituqwa Yañez, Ivan
AU - Peláez Ballesta, Ana
AU - Soriano, Víctor
AU - Moreno Escobar, Eduardo
AU - Peña Monje, Alejandro
AU - Sánchez Cabrera, Valme
AU - Vinuesa García, David
AU - Arrizabalaga Asenjo, María
AU - Cifuentes Luna, Carmen
AU - Núñez Morcillo, Juana
AU - Cruz Pérez Seco, Ma
AU - Villoslada Gelabert, Aroa
AU - Aured Guallar, Carmen
AU - Fernández Abad, Nuria
AU - García Mangas, Pilar
AU - Matamala Adell, Marta
AU - Pilar Palacián Ruiz, Ma
AU - Carlos Porres, Juan
AU - Alcaraz Vidal, Begoña
AU - Cobos Trigueros, Nazaret
AU - Jesús Del Amor Espín, María
AU - Antonio Giner Caro, José
AU - Jiménez Sánchez, Roberto
AU - Jimeno Almazán, Amaya
AU - Ortín Freire, Alejandro
AU - Viqueira González, Monserrat
AU - Pericás Ramis, Pere
AU - Ángels Ribas Blanco, Ma
AU - Ruiz De Gopegui Bordes, Enrique
AU - Vidal Bonet, Laura
AU - Carmen Bellón Munera, Ma
AU - Escribano Garaizabal, Elena
AU - Tercero Martínez, Antonia
AU - Carlos Segura Luque, Juan
N1 - Funding Information: Financial support. This work was supported by the Ministerio de Economia and Competitividad (Madrid, Spain) (FIS NCT00871104, Instituto de Salud Carlos III). J. M. P. received a “Rio Hortega” research grant from Instituto de Salud Carlos III and the Ministerio de Economia and Competitividad (Madrid, Spain) and the European Society for Clinical Microbiology and Infectious Diseases and Federation of European Microbiological Societies Research Fellowship 2016. Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (Madrid, Spain) provided J. M. M. with a personal intensification research grant (INT15/00168) during 2016 and a personal 80:20 research grant from the Institut d’Investi-gacions Biomèdiques Pi i Sunyer for the period 2017–2019. Funding Information: Potential conflicts of interest. J. M. M. has received consulting honoraria and/or research grants from AbbVie, Angelini, Bristol-Myers Squibb, Contrafect, Cubist, Genentech, Medtronic, MSD, Novartis, Gilead Sciences, and ViiV Healthcare outside the submitted work. All other authors report no potential conflicts. 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. Publisher Copyright: © 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/11/15
Y1 - 2019/11/15
N2 - Background: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods: Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. Results: A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P <. 001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P =. 01) and cardiac surgery (OR, 0.24; 95% CI,. 09-.63; P =. 04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI,. 22-.98; P =. 007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions: OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
AB - Background: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods: Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. Results: A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P <. 001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P =. 01) and cardiac surgery (OR, 0.24; 95% CI,. 09-.63; P =. 04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI,. 22-.98; P =. 007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions: OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
KW - hospitalization
KW - infective endocarditis
KW - outcomes
KW - outpatient parenteral antibiotic treatment
KW - readmission
UR - http://www.scopus.com/inward/record.url?scp=85065626073&partnerID=8YFLogxK
U2 - 10.1093/cid/ciz030
DO - 10.1093/cid/ciz030
M3 - Artículo
C2 - 30649282
AN - SCOPUS:85065626073
SN - 1058-4838
VL - 69
SP - 1690
EP - 1700
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -