Infective endocarditis: GAMES data support expanding OPAT criteria

  • Pericà JM et al
  • Clin Infect Dis

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Outpatient parenteral antibiotic treatment (OPAT) is safe/effective for patients with infective endocarditis (IE) not meeting Infectious Diseases Society of America (IDSA), and American Heart Association (AHA) criteria.
  • Failure to fulfill criteria not associated with readmission or mortality.

Why this matters

  • Consider expanding OPAT for IE patients lacking difficult-to-treat microorganisms (requiring complicated antibiotic combinations), or presenting with clinical, echocardiographic or postsurgical complications that resolve shortly postonset.
  • Recommendations to expand indication should be restricted to centers with established OPAT programs.

Key results

  • 429 OPAT, 1003 home-based antibiotic treatment (HBAT) patients.
  • 57.1%, 27.3%, 18.6% OPAT patients, respectively, had native, prosthetic, pacemaker/defibrillator IE.
  • Most common causative pathogens in OPAT group were viridans group streptococci (18.6%), coagulase-negative staphylococci (14.5%).
  • Only 21.7% fulfilled IDSA criteria.
  • 29% vs 37.5% OPAT, HBAT patients, respectively, had new-onset/worsening heart failure.
  • Median length of antibiotic treatment, 42.0 (interquartile range, 32-54) vs 42.0 (29-45) days, OPAT, HBAT.
  • No significant differences in readmission 3-month postdischarge (10.9% vs 10%, OPAT, HBAT, respectively); 1-year mortality was higher in HBAT patients (12.5% vs 7.7%, OPAT; P=.004).

Study design

  • Analysis of data from the multicenter Spanish GAMES cohort, comparing outcomes of OPAT vs HBAT for IE.
  • Funding: Ministerio de Sanidad y Consumo of Spain, others.

Limitations

  • Retrospective design.
  • Patient management heterogeneity.

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