Management of infective endocarditis in outpatients: clinical experience with outpatient parenteral antibiotic therapy.
BACKGROUND
There is limited experience in treating infective endocarditis (IE) with outpatient parenteral antibiotic therapy (OPAT).


METHODS
Following institutional review board (IRB) approval, patients discharged from Baystate Medical Center with IE documented by modified Duke criteria treated with OPAT were identified. Data obtained included organisms implicated, indications of clinical stability, percentage of total therapy rendered after hospitalization, and one year follow up.


RESULTS
Forty-three patients met criteria. Thirty-five percent were infected with staphylococci; 38% harbored streptococci or enterococci. Native valves and left-sided valves each constituted approximately 75% of total. All patients received >4 weeks of therapy, with >66% rendered after hospital discharge A median of 7 days of hemodynamic stability and negative blood cultures occurred prior to discharge. After one year, no patients died from IE. Twenty-three percent were hospitalized during OPAT from intravenous catheter, antibiotic, or other complications, but none for direct complications of IE.


CONCLUSIONS
OPAT for IE can be safely utilized, and at least 66% of care can be given in this manner. Our investigation provides enhanced data on employing OPAT for IE caused by staphylococci, left-sided infections, and also provides outcomes after one year after treatment.
Larioza
Julius
J
Infectious Disease Division, Room S2657, Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, USA. julius.larioza@bhs.org
Heung
Lena
L
Girard
Amy
A
Brown
Richard B
RB
D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents