Association Between Vegetation Size and Outcome in the Partial Oral Antibiotic Endocarditis Treatment Trial.

Autor: Carter-Storch R; Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: rcarterstorch@gmail.com., Pries-Heje MM; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark., Povlsen JA; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Christensen U; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Gill SU; Department of Cardiology, Odense University Hospital, Odense, Denmark., Hjulmand JG; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark., Bruun NE; Department of Cardiology, Zeeland University Hospital, Roskilde, Denmark., Elming H; Department of Cardiology, Zeeland University Hospital, Roskilde, Denmark., Madsen T; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Fuursted K; Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark., Schultz M; Department of Cardiology, Herlev Hospital, Copenhagen, Denmark., Christensen JJ; The Regional Department of Clinical Microbiology, Zealand University Hospital, Roskilde, Denmark., Rosenvinge F; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark., Helweg-Larsen J; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark., Fosbøl E; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Køber L; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark., Torp-Pedersen C; Department of Cardiology, University of Copenhagen, Copenhagen, Denmark., Tønder N; Department of Cardiology, University of Copenhagen, Copenhagen, Denmark., Moser C; Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark., Iversen K; Department of Cardiology, Herlev Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Bundgaard H; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark., Ihlemann N; Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Jul 01; Vol. 222, pp. 131-140. Date of Electronic Publication: 2024 May 03.
DOI: 10.1016/j.amjcard.2024.04.058
Abstrakt: 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.
Competing Interests: Declaration of competing interest The authors have no competing interests to declare.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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