Outpatient parenteral antimicrobial therapy is safe and effective for the treatment of infective endocarditis: a retrospective cohort study.
BACKGROUND
Outpatient parenteral antibiotic therapy has been shown to be efficacious, safe and cost-effective for a variety of infections. The data from managing infective endocarditis (IE) with hospital in the home (HITH) are limited. We evaluated the safety and outcomes of patients with IE treated with HITH at our centre.


OBJECTIVE
To evaluate the safety, efficacy and 1-year outcomes of patients with IE treated under HITH at our centre over 9 years.


METHODS
A retrospective analysis of the clinical outcomes of all cases of IE treated with HITH at a tertiary referral centre was undertaken for patients treated between June 2002 and July 2011 (9 years). Outcome measures included clinical cure, readmission rate, relapses and 1-year mortality.


RESULTS
Sixty-eight cases of IE were treated with HITH over the study period, including 29 native valve infections, 24 prosthetic valve infections, 12 pacemaker lead infections, 1 defibrillator lead infection, 1 myocardial wall infection and 1 aortic graft infection. Thirteen cases had valve replacement surgery and 12 cases had removal of infected pacemaker leads. Staphylococcus aureus (18 cases), Coagulase-negative staphylococcus (10 cases) and viridians-group streptococcus (18 cases) were the most common pathogens. Median duration of antimicrobial therapy with HITH was 24 days (range 4 to 42 days). There were three readmissions during antimicrobial therapy with HITH. Two patients relapsed. There were two deaths and one patient was lost to follow up. One-year survival was 96% (65/68).


CONCLUSIONS
Outpatient antimicrobial therapy with HITH is safe and effective in carefully selected cases of IE.
Barwon Health, Geelong, Australia. anthonykwanfu.htin@gmail.com
A K F
AK
Htin
N D
ND
Friedman
A
A
Hughes
D P
DP
O'Brien
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S
Huffam
A-M
AM
Redden
E
E
Athan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004696:Endocarditis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents