Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Cardiology Journal
MENU
Shortcuts Submit an article CJ Guide for Authors (new) Recent articles Special collections Ahead Of Print APIS-S Online Calculator OCT Contrast Calculator Reviewers 2022

open access

Vol 28, No 4 (2021)
Original Article
Submitted: 2021-02-15
Accepted: 2021-04-23
Published online: 2021-05-21
View PDF Download PDF file
Get Citation

Long-term antibiotic therapy in patients with surgery-indicated not undergoing surgery infective endocarditis

Nuria Vallejo Camazon12, Lourdes Mateu3, Germán Cediel1, Laura Escolà-Vergé4, Nuria Fernández-Hidalgo4, Mercedes Gurgui Ferrer5, Maria Teresa Perez Rodriguez6, Guillermo Cuervo7, Raquel Nuñez Aragón8, Cinta Llibre1, Nieves Sopena3, Maria Dolores Quesada9, Elisabeth Berastegui1, Albert Teis1, Jorge Lopez Ayerbe1, Gladys Juncà1, Francisco Gual1, Elena Ferrer Sistach1, Ainhoa Vivero8, Esteban Reynaga3, Maria Hernández Pérez10, Christian Muñoz Guijosa1, Lluisa Pedro-Botet23, Antoni Bayés-Genís12
DOI: 10.5603/CJ.a2021.0054
·
Pubmed: 34031866
·
Cardiol J 2021;28(4):566-578.
Affiliations
  1. Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
  2. Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
  3. Unitat Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
  4. Servei de Malalties Infeccioses, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
  5. Unitat de Malalties Infeccioses, Hospital Santa Creu i Sant Pau,Universitat Autonoma de Barcelona, Barcelona, Spain
  6. Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario de Vigo, Vigo, Spain
  7. Department of Infectious Diseases, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
  8. Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
  9. Microbiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
  10. Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

open access

Vol 28, No 4 (2021)
Original articles — Clinical cardiology
Submitted: 2021-02-15
Accepted: 2021-04-23
Published online: 2021-05-21

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.

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.

Full Text:

View PDF Download PDF file
Get Citation

Keywords

suppressive antibiotic treatment, infective endocarditis, surgery

About this article
Title

Long-term antibiotic therapy in patients with surgery-indicated not undergoing surgery infective endocarditis

Journal

Cardiology Journal

Issue

Vol 28, No 4 (2021)

Article type

Original Article

Pages

566-578

Published online

2021-05-21

Page views

1702

Article views/downloads

1177

DOI

10.5603/CJ.a2021.0054

Pubmed

34031866

Bibliographic record

Cardiol J 2021;28(4):566-578.

Keywords

suppressive antibiotic treatment
infective endocarditis
surgery

Authors

Nuria Vallejo Camazon
Lourdes Mateu
Germán Cediel
Laura Escolà-Vergé
Nuria Fernández-Hidalgo
Mercedes Gurgui Ferrer
Maria Teresa Perez Rodriguez
Guillermo Cuervo
Raquel Nuñez Aragón
Cinta Llibre
Nieves Sopena
Maria Dolores Quesada
Elisabeth Berastegui
Albert Teis
Jorge Lopez Ayerbe
Gladys Juncà
Francisco Gual
Elena Ferrer Sistach
Ainhoa Vivero
Esteban Reynaga
Maria Hernández Pérez
Christian Muñoz Guijosa
Lluisa Pedro-Botet
Antoni Bayés-Genís

References (48)
  1. Hoen B, Duval X. Infective endocarditis. N Engl J Med. 2013; 368(15): 1425–1433.
    CrossRef
  2. Østergaard L, Oestergaard LB, Lauridsen TK, et al. Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment: a nationwide population-based study. Eur J Cardiothorac Surg. 2018; 54(5): 860–866.
    CrossRefPubMed
  3. Thuny F, Grisoli D, Collart F, et al. Management of infective endocarditis: challenges and perspectives. Lancet. 2012; 379(9819): 965–975.
    CrossRefPubMed
  4. Cahill TJ, Baddour LM, Habib G, et al. Challenges in Infective Endocarditis. J Am Coll Cardiol. 2017; 69(3): 325–344.
    CrossRefPubMed
  5. San Román JA, Vilacosta I, López J, et al. Critical questions about left-sided infective endocarditis. J Am Coll Cardiol. 2015; 66(9): 1068–1076.
    CrossRefPubMed
  6. Olmos C, Vilacosta I, Fernández-Pérez C, et al. The evolving nature of infective endocarditis in spain: a population-based study (2003 to 2014). J Am Coll Cardiol. 2017; 70(22): 2795–2804.
    CrossRefPubMed
  7. Delahaye F, Duclos A. Is infective endocarditis changing over time? J Am Coll Cardiol. 2017; 70(22): 2805–2807.
    CrossRefPubMed
  8. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009; 169(5): 463–473.
    CrossRefPubMed
  9. Fernández-Hidalgo N, Almirante B. Current status of infectious endocarditis: New populations at risk, new diagnostic and therapeutic challenges. Enferm Infecc Microbiol Clin. 2018; 36(2): 69–71.
    CrossRefPubMed
  10. Habib G, Lancellotti P, Antunes M, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015; 36(44): 3075–3128.
    CrossRef
  11. Chu VH, Park LP, Athan E, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation. 2015; 131(2): 131–140.
    CrossRefPubMed
  12. Iung B, Doco-Lecompte T, Chocron S, et al. AEPEI Study Group. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J. 2016; 37(10): 840–848.
    CrossRefPubMed
  13. Habib G, Erba PA, Iung B. et el. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019; 40(39): 3222–3232.
    CrossRefPubMed
  14. Vallejo Camazón N, Cediel G, Núñez Aragón R, et al. Short- and long-term mortality in patients with left-sided infective endocarditis not undergoing surgery despite indication. Rev Esp Cardiol (Engl Ed). 2020; 73(9): 734–740.
    CrossRefPubMed
  15. Iversen K, Ihlemann N, Gill SU, et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med. 2019; 380(5): 415–424.
    CrossRefPubMed
  16. Millar BC, Habib G, Moore JE. New diagnostic approaches in infective endocarditis. Heart. 2016; 102(10): 796–807.
    CrossRefPubMed
  17. Millar BC, de Camargo RA, Alavi A, et al. PET/Computed tomography evaluation of infection of the heart. PET Clin. 2019; 14(2): 251–269.
    CrossRefPubMed
  18. Puerta-Alcalde P, Cuervo G, Simonetti AF, et al. PET/CT added to Duke criteria facilitates diagnosis and monitoring of long-term suppressive therapy of prosthetic endocarditis. Infect Dis (Lond). 2017; 49(9): 698–701.
    CrossRefPubMed
  19. Núñez Aragón R, Pedro-Botet Montoya ML, Mateu Pruñonosa L, et al. Factores asociados y análisis descriptivo de la endocarditis infecciosa adquirida en el entorno hospitalario de un centro terciario de referencia. Enferm Infecc Microbiol Clin. 2013; 31(1): 15–22.
    CrossRef
  20. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5): 373–383.
    CrossRefPubMed
  21. Nashef S, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardio-Thoracic Surg. 1999; 16(1): 9–13.
    CrossRef
  22. Nashef SAM, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012; 41(4): 734–44; discussion 744.
    CrossRefPubMed
  23. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the american heart association. Circulation. 2015; 132(15): 1435–1486.
    CrossRefPubMed
  24. Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010; 121(9): 1141–1152.
    CrossRefPubMed
  25. Fernández-Hidalgo N, Almirante B, Tornos P, et al. Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital. Clin Microbiol Infect. 2012; 18(12): E522–E530.
    CrossRefPubMed
  26. Hidalgo-Tenorio C, Vinuesa D, Plata A, et al. DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci. Ann Clin Microbiol Antimicrob. 2019; 18(1): 30.
    CrossRefPubMed
  27. Spaziante M, Franchi C, Taliani G, et al. Serum bactericidal activity levels monitor to guide intravenous dalbavancin chronic suppressive therapy of inoperable staphylococcal prosthetic valve endocarditis: a case report. Open Forum Infect Dis. 2019; 6(11): ofz427.
    CrossRefPubMed
  28. Al-Omari A, Cameron DW, Lee C, et al. Oral antibiotic therapy for the treatment of infective endocarditis: a systematic review. BMC Infect Dis. 2014; 14: 140.
    CrossRefPubMed
  29. Mzabi A, Kernéis S, Richaud C, et al. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients. Clin Microbiol Infect. 2016; 22(7): 607–612.
    CrossRefPubMed
  30. Heldman AW, Hartert TV, Ray SC, et al. Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users: prospective randomized comparison with parenteral therapy. Am J Med. 1996; 101(1): 68–76.
    CrossRefPubMed
  31. Stamboulian D, Bonvehi P, Arevalo C, et al. Antibiotic management of outpatients with endocarditis due to penicillin-susceptible streptococci. Rev Infect Dis. 1991; 13 Suppl 2: S160–S163.
    CrossRefPubMed
  32. Tissot-Dupont H, Gouriet F, Oliver L, et al. High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis. Int J Antimicrob Agents. 2019; 54(2): 143–148.
    CrossRefPubMed
  33. Cunha BA, Brahmbhatt K, Raza M. Haemophilus parainfluenzae aortic prosthetic valve endocarditis (PVE) successfully treated with oral levofloxacin. Heart Lung. 2015; 44(4): 317–320.
    CrossRefPubMed
  34. Baddour LM. Long-term suppressive therapy for fungal endocarditis. Clin Infect Dis. 1996; 23(6): 1338–1340.
    CrossRefPubMed
  35. Tan EM, DeSimone DC, Sohail MR, et al. Outcomes in patients with cardiovascular implantable electronic device infection managed with chronic antibiotic suppression. Clin Infect Dis. 2017; 64(11): 1516–1521.
    CrossRefPubMed
  36. Baddour LM. Long-term suppressive antimicrobial therapy for intravascular device-related infections. Am J Med Sci. 2001; 322(4): 209–212.
    CrossRefPubMed
  37. Lechner AM, Pretsch I, Hoppe U, et al. Successful long-term antibiotic suppressive therapy in a case of prosthetic valve endocarditis and a case of extensive aortic and subclavian graft infection. Infection. 2020; 48(1): 133–136.
    CrossRefPubMed
  38. Takano T, Terasaki T, Wada Y, et al. Treatment of prosthetic graft infection after thoracic aorta replacement. Ann Thorac Cardiovasc Surg. 2014; 20(4): 304–309.
    CrossRefPubMed
  39. Ramos-Martínez A, Blanco-Alonso S, Calderón-Parra J, et al. Endocarditis in patients with ascending aortic prosthetic graft: a series from a national referral hospital. J Am Coll Cardiol. 2020; 75(18): 2380–2382.
    CrossRefPubMed
  40. Swart LE, Gomes A, Scholtens AM, et al. Improving the diagnostic performance of f-fluorodeoxyglucose positron-emission tomography/computed tomography in prosthetic heart valve endocarditis. Circulation. 2018; 138(14): 1412–1427.
    CrossRefPubMed
  41. Pizzi M, Roque A, Fernández-Hidalgo N, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18 f-fluordeoxyglucose positron emission tomography/computed tomography angiography. Circulation. 2015; 132(12): 1113–1126.
    CrossRef
  42. Heuzé C, Lepage L, Loubet P, et al. Infective endocarditis after bentall surgery: usefulness of new imaging modalities and outcomes. JACC Cardiovasc Imaging. 2018; 11(10): 1535–1537.
    CrossRefPubMed
  43. Saitto G, Russo M, Pugliese M, et al. Infectious aortic root pseudoaneurysm after bentall procedure: to treat or not to treat by redo operation? Aorta (Stamford). 2019; 7(3): 90–92.
    CrossRefPubMed
  44. Machelart I, Greib C, Wirth G, et al. Graft infection after a Bentall procedure: A case series and systematic review of the literature. Diagn Microbiol Infect Dis. 2017; 88(2): 158–162.
    CrossRefPubMed
  45. Baddour LM, Cha YM, Wilson WR. Clinical practice. Infections of cardiovascular implantable electronic devices. N Engl J Med. 2012; 367(9): 842–849.
    CrossRefPubMed
  46. Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditis-related mortality with a management-based approach. Arch Intern Med. 2009; 169(14): 1290–1298.
    CrossRefPubMed
  47. Chirillo F, Scotton P, Rocco F, et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis. Am J Cardiol. 2013; 112(8): 1171–1176.
    CrossRefPubMed
  48. Kaura A, Byrne J, Fife A, et al. Inception of the 'endocarditis team' is associated with improved survival in patients with infective endocarditis who are managed medically: findings from a before-and-after study. Open Heart. 2017; 4(2): e000699.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl