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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 Camazón, Lourdes Mateu, Germán Cediel, Laura Escolà-Vergé, Nuria Fernandez-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
DOI: 10.5603/CJ.a2021.0054
·
Pubmed: 34031866

open access

Ahead of print
Original articles
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, the aim herein, was to evaluate the 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 an 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, the aim herein, was to evaluate the 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 an 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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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

Ahead of print

Article type

Original Article

Published online

2021-05-21

DOI

10.5603/CJ.a2021.0054

Pubmed

34031866

Keywords

suppressive antibiotic treatment
infective endocarditis
surgery

Authors

Nuria Vallejo Camazón
Lourdes Mateu
Germán Cediel
Laura Escolà-Vergé
Nuria Fernandez-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

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