TY - JOUR
T1 - Association Between Vegetation Size and Outcome in the Partial Oral Antibiotic Endocarditis Treatment Trial
AU - Carter-Storch, Rasmus
AU - Pries-Heje, Mia Marie
AU - Povlsen, Jonas A
AU - Christensen, Ulrik
AU - Gill, Sabine U
AU - Glud Hjulmand, Julie
AU - Bruun, Niels E
AU - Elming, Hanne
AU - Madsen, Trine
AU - Fuursted, Kurt
AU - Schultz, Martin
AU - Christensen, Jens J
AU - Rosenvinge, Flemming
AU - Helweg-Larsen, Jannik
AU - Fosbøl, Emil
AU - Køber, Lars
AU - Torp-Pedersen, Christian
AU - Tønder, Niels
AU - Moser, Claus
AU - Iversen, Kasper
AU - Bundgaard, Henning
AU - Ihlemann, Nikolaj
PY - 2024/7
Y1 - 2024/7
N2 - Step-down oral antibiotic therapy is associated with a non-inferior long-term outcome compared with continued intravenous antibiotic therapy in the treatment of left-sided infective endocarditis. We aimed to analyze whether step-down oral therapy compared with continued intravenous antibiotic therapy is also associated with a non-inferior outcome in patients with large vegetations (vegetation length ≥ 10 mm) or among patients who underwent surgery before step-down oral therapy. We included patients without presence of aortic root abscess at diagnosis from the POET (Partial Oral Antibiotic Endocarditis Treatment) study. Multivariable Cox regression analyses were used to find associations between large vegetation, cardiac surgery, step-down oral therapy, and the primary end point (composite of all-cause mortality, unplanned cardiac surgery, embolic event, or relapse of positive blood cultures during follow-up). A total of 368 patients (age 68 ± 12, 77% men) were included. Patients with large vegetations (n = 124) were more likely to undergo surgery compared with patients with small vegetations (n = 244) (65% vs 20%, p <0.001). During a median 1,406 days of follow-up, 146 patients reached the primary end point. Large vegetations were not associated with the primary end point (hazard ratio 0.74, 95% confidence interval 0.47 to 1.18, p = 0.21). Step-down oral therapy was non-inferior to continued intravenous antibiotic in all subgroups when stratified by the presence of a large vegetation at baseline and early cardiac surgery. Step-down oral therapy is safe in the presence of a large vegetation at diagnosis and among patients who underwent early cardiac surgery.
AB - Step-down oral antibiotic therapy is associated with a non-inferior long-term outcome compared with continued intravenous antibiotic therapy in the treatment of left-sided infective endocarditis. We aimed to analyze whether step-down oral therapy compared with continued intravenous antibiotic therapy is also associated with a non-inferior outcome in patients with large vegetations (vegetation length ≥ 10 mm) or among patients who underwent surgery before step-down oral therapy. We included patients without presence of aortic root abscess at diagnosis from the POET (Partial Oral Antibiotic Endocarditis Treatment) study. Multivariable Cox regression analyses were used to find associations between large vegetation, cardiac surgery, step-down oral therapy, and the primary end point (composite of all-cause mortality, unplanned cardiac surgery, embolic event, or relapse of positive blood cultures during follow-up). A total of 368 patients (age 68 ± 12, 77% men) were included. Patients with large vegetations (n = 124) were more likely to undergo surgery compared with patients with small vegetations (n = 244) (65% vs 20%, p <0.001). During a median 1,406 days of follow-up, 146 patients reached the primary end point. Large vegetations were not associated with the primary end point (hazard ratio 0.74, 95% confidence interval 0.47 to 1.18, p = 0.21). Step-down oral therapy was non-inferior to continued intravenous antibiotic in all subgroups when stratified by the presence of a large vegetation at baseline and early cardiac surgery. Step-down oral therapy is safe in the presence of a large vegetation at diagnosis and among patients who underwent early cardiac surgery.
KW - cardiac surgery
KW - infective endocarditis
KW - stroke
KW - transesophageal echocardiography
KW - Follow-Up Studies
KW - Administration, Oral
KW - Endocarditis, Bacterial/drug therapy
KW - Humans
KW - Middle Aged
KW - Male
KW - Treatment Outcome
KW - Administration, Intravenous
KW - Cardiac Surgical Procedures
KW - Female
KW - Aged
KW - Anti-Bacterial Agents/therapeutic use
U2 - 10.1016/j.amjcard.2024.04.058
DO - 10.1016/j.amjcard.2024.04.058
M3 - Journal article
C2 - 38703884
SN - 0002-9149
VL - 222
SP - 131
EP - 140
JO - The American Journal of Cardiology
JF - The American Journal of Cardiology
ER -