Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort
Authors: Pericà    s Juan M , Llopis Jaume , González-Ramallo Víctor , Goenaga Miguel Á , Muñoz Patricia , García-Leoni M Eugenia , Fariñas M Carmen , Pajarón Marcos , Ambrosioni Juan , Luque Rafael , Goikoetxea Josune , Oteo José A , Carrizo Enara , Bodro Marta , Reguera-Iglesias José M , Navas Enrique , Hidalgo-Tenorio Carmen , Miró José M ,   Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) investigators, Fernández Sánchez Fernando , Noureddine Mariam , Rosas Gabriel , de la Torre Lima Javier , Blanco Roberto , Victoria Boado María , Campaña Lázaro Marta , Crespo Alejandro , Goikoetxea Josune , Ramón Iruretagoyena José , Irurzun Zuazabal Josu , López-Soria Leire , Montejo Miguel , Nieto Javier , Rodrigo David , Rodríguez Regino , Vitoria Yolanda , Voces Roberto , Mª María , García López Victoria , Ivanova Georgieva Radka , Ojeda Guillermo , Rodríguez Bailón Isabel , Ruiz Morales Josefa , María Cuende Ana , Echeverría Tomás , Fuerte Ana , Gaminde Eduardo , Ángel Goenaga Miguel , Idígoras Pedro , Antonio Iribarren José , Izaguirre Yarza Alberto , Kortajarena Urkola Xabier , Reviejo Carlos , Carrasco Rafael , Climent Vicente , Llamas Patricio , Merino Esperanza , Plazas Joaquín , Reus Sergio , Álvarez Nemesio , María Bravo-Ferrer José , Castelo Laura , Cuenca José , Llinares Pedro , Miguez Rey Enrique , Rodríguez Mayo María , Sánchez Efrén , Sousa Regueiro Dolores , Javier Martínez Francisco , del Mar Alonso Mª , Castro Beatriz , García Rosado Dácil , del Carmen Durán Mª , Antonia Miguel Gómez Mª , Lacalzada Juan , Nassar Ibrahim , Plata Ciezar Antonio , Mª Reguera Iglesias José , Asensi Álvarez Víctor , Costas Carlos , de la Hera Jesús , Fernández Suárez Jonnathan , Iglesias Fraile Lisardo , León Arguero Víctor , López Menéndez José , Mencia Bajo Pilar , Morales Carlos , Moreno Torrico Alfonso , Palomo Carmen , Paya Martínez Begoña , Rodríguez Esteban Ángeles , Rodríguez García Raquel , Telenti Asensio Mauricio , Almela Manuel , Ambrosioni Juan , Azqueta Manuel , Brunet Mercè , Bodro Marta , Cartañá Ramón , Falces Carlos , Fita Guillermina , Fuster David , García de la Mària Cristina , García-Valls Laura , Hernández-Meneses Marta , Llopis Pérez Jaume , Marco Francesc , Miró José M , Moreno Asunción , Nicolás David , Ninot Salvador , Quintana Eduardo , Paré Carlos , Pereda Daniel , Pericás Juan M , Pomar José L , Ramírez José , Rovira Irene , Sandoval Elena , Sala Marta , Sitges Marta , Soy Dolors , Téllez Adrián , Tolosana José M , Vidal Bárbara , Vila Jordi , Adán Iván , Bermejo Javier , Bouza Emilio , Celemín Daniel , Cuerpo Caballero Gregorio , Delgado Montero Antonia , Fernández Cruz Ana , García Mansilla Ana , Eugenia García Leoni Mª , González Ramallo Víctor , Kestler Hernández Martha , Mari Hualde Amaia , Marín Mercedes , Martínez-Sellés Manuel , Cruz Menárguez Mª , Muñoz Patricia , Rincón Cristina , Rodríguez-Abella Hugo , Rodríguez-Créixems Marta , Pinilla Blanca , Pinto Ángel , Valerio Maricela , Vázquez Pilar , Verde Moreno Eduardo , Antorrena Isabel , Loeches Belén , Martín Quirós Alejandro , Moreno Mar , Ramírez Ulises , Rial Bastón Verónica , Romero María , Saldaña Araceli , Agüero Balbín Jesús , Armiñanzas Castillo Carlos , Arnaiz Ana , Arnaiz de las Revillas Francisco , Cobo Belaustegui Manuel , Carmen Fariñas María , Fariñas-Álvarez Concepción , Gómez Izquierdo Rubén , García Iván , González Rico Claudia , Gutiérrez-Cuadra Manuel , Gutiérrez Díez José , Pajarón Marcos , Antonio Parra José , Teira Ramón , Zarauza Jesús , Domínguez Fernando , García Pavía Pablo , González Jesús , Orden Beatriz , Ramos Antonio , Centella Tomasa , Manuel Hermida José , Luis Moya José , Martín-Dávila Pilar , Navas Enrique , Oliva Enrique , del Río Alejandro , Rodríguez-Roda Stuart Jorge , Ruiz Rodríguez Soledad , Hidalgo Tenorio Carmen , Almendro Delia Manuel , Araji Omar , Miguel Barquero José , Calvo Jambrina Román , de Cueto Marina , Gálvez Acebal Juan , Méndez Irene , Morales Isabel , Eduardo López-Cortés Luis , de Alarcón Arístides , García Emilio , Luis Haro Juan , Antonio Lepe José , López Francisco , Luque Rafael , Javier Alonso Luis , Azcárate Pedro , Manuel Azcona Gutiérrez José , Ramón Blanco José , García-Álvarez Lara , Antonio Oteo José , Sanz Mercedes , de Benito Natividad , Gurguí Mercé , Pacho Cristina , Pericas Roser , Pons Guillem , Álvarez M , Fernández A L , Martínez Amparo , Prieto A , Regueiro Benito , Tijeira E , Vega Marino , Canut Blasco Andrés , Cordo Mollar José , Carlos Gainzarain Arana Juan , García Uriarte Oscar , Martín López Alejandro , Ortiz de Zárate Zuriñe , Antonio Urturi Matos José , García Domínguez Gloria , Sánchez-Porto Antonio , Mª Arribas Leal José , García Vázquez Elisa , Hernández Torres Alicia , Blázquez Ana , de la Morena Valenzuela Gonzalo , Alonso Ángel , Aramburu Javier , Elena Calvo Felicitas , Moreno Rodríguez Anai , Tarabini-Castellani Paola , Heredero Gálvez Eva , Maicas Bellido Carolina , Largo Pau José , Antonia Sepúlveda Mª , Toledano Sierra Pilar , Zafar Iqbal-Mirza Sadaf , Cascales Alcolea Eva , Egea Serrano Pilar , Joaquín Hernández Roca José , Keituqwa Yañez Ivan , Peláez Ballesta Ana , Soriano Víctor , Moreno Escobar Eduardo , Peña Monje Alejandro , Sánchez Cabrera Valme , Vinuesa García David , Arrizabalaga Asenjo María , Cifuentes Luna Carmen , Núñez Morcillo Juana , Cruz Pérez Seco Mª , Villoslada Gelabert Aroa , Aured Guallar Carmen , Fernández Abad Nuria , García Mangas Pilar , Matamala Adell Marta , Pilar Palacián Ruiz Mª , Carlos Porres Juan , Alcaraz Vidal Begoña , Cobos Trigueros Nazaret , Jesús Del Amor Espín María , Antonio Giner Caro José , Jiménez Sánchez Roberto , Jimeno Almazán Amaya , Ortín Freire Alejandro , Viqueira González Monserrat , Pericás Ramis Pere , Ángels Ribas Blanco Mª , Ruiz de Gopegui Bordes Enrique , Vidal Bonet Laura , Carmen Bellón Munera Mª , Escribano Garaizabal Elena , Tercero Martínez Antonia , Carlos Segura Luque Juan 
Published: January 2019

Abstract

Background
Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT).

Methods
Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008–2012) was performed.

Results
A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56–76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32–54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04–1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09–.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22–.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission.

Conclusions
OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.