Vol 28, No 4 (2021)
Original Article
Published online: 2021-05-21

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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
Pubmed: 34031866
Cardiol J 2021;28(4):566-578.


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.

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