Outpatient Parenteral Antibiotic Treatment vs Hospitalization for Infective Endocarditis: Validation of the OPAT-GAMES Criteria
Authors: Pericàs Juan M , Llopis Jaume , Muñoz Patricia , González-Ramallo Víctor , García-Leoni M Eugenia , de Alarcón Arístides , Luque Rafael , Fariñas M Carmen , Goenaga Miguel Á , Hernández-Meneses Marta , Nicolás David , Ramos-Martínez Antonio , Rodríguez-Esteban M Ángeles , Villoslada-Gelabert Aroa , Miró José M ,   GAMES Investigators, Sánchez Fernando Fernández , Noureddine Mariam , Rosas Gabriel , Lima Javier de la Torre , Bereciartua Elena , Blanco Roberto , Boado María Victoria , Lázaro Marta Campaña , Crespo Alejandro , Carrión Laura Guio , Del Álamo Martínez de Lagos Mikel , Ugarte Gorane Euba , Goikoetxea Josune , Hierro Marta Ibarrola , Iruretagoyena José Ramón , Zuazabal Josu Irurzun , López-Soria Leire , Montejo Miguel , Nieto Javier , Rodrigo David , Rodríguez Regino , Vitoria Yolanda , Voces Roberto , López Mª Victoria García , Georgieva Radka Ivanova , Ojeda Guillermo , Bailón Isabel Rodríguez , Morales Josefa Ruiz , Galparsoro Harkaitz Azkune , Boronat Elisa Berritu , Odriozola Mª Jesús Bustinduy , Martín Cristina del Bosque , Echeverría Tomás , Yarza Alberto Eizaguirre , Fuentes Ana , Goenaga Miguel Ángel , del Río Muskilda Goyeneche , Bauza Ángela Granda , Iribarren José Antonio , Urkola Xabier Kortajarena , López José Ignacio Pérez-Moreiras , Jiménez Ainhoa Rengel , Reviejo Karlos , Berbejillo Alberto Sáez , Haza Elou Sánchez , Alda Rosa Sebastián , Ruiz Itziar Solla , Ugartemendia Irati Unamuno , Anza Diego Vicente , Benito Iñaki Villanueva , Arrieta Mar Zabalo , Carrasco Rafael , Climent Vicente , Llamas Patricio , Merino Esperanza , Plazas Joaquín , Reus Sergio , Álvarez Nemesio , Bravo-Ferrer José María , Castelo Laura , Cuenca José , Llinares Pedro , Rey Enrique Miguez , Mayo María Rodríguez , Sánchez Efrén , Regueiro Dolores Sousa , Martínez Francisco Javier , Alonso Mª del Mar , Castro Beatriz , Melian Teresa Delgado , Sarabia Javier Fernández , Rosado Dácil García , González Julia González , Lacalzada Juan , de la Peña Lissete Lorenzo , Ramírez Alina Pérez , Arrondo Pablo Prada , Moreno Fermín Rodríguez , Ciezar Antonio Plata , Iglesias José Mª Reguera , Álvarez Víctor Asensi , Costas Carlos , de la Hera Jesús , Suárez Jonnathan Fernández , Fraile Lisardo Iglesias , Arguero Víctor León , Menéndez José López , Bajo Pilar Mencia , Morales Carlos , Torrico Alfonso Moreno , Palomo Carmen , Martínez Begoña Paya , Esteban Ángeles Rodríguez , García Raquel Rodríguez , Asensio Mauricio Telenti , Almela Manuel , Ambrosioni Juan , Azqueta Manel , Brunet Mercè , Bodro Marta , Cartañá Ramón , Cuervo Guillermo , Falces Carlos , Fita Guillermina , Fuster David , de la Mària Cristina García , García-Pares Delia , Hernández-Meneses Marta , Pérez Jaume Llopis , Marco Francesc , Miró José M , Moreno Asunción , Nicolás David , Ninot Salvador , Quintana Eduardo , Paré Carlos , Pereda Daniel , Pericàs Juan M , Pomar José L , Ramírez José , Rovira Irene , Sandoval Elena , Sitges Marta , Soy Dolors , Téllez Adrián , Tolosana José M , Vidal Bárbara , Vila Jordi , Adán Iván , Alonso Juan Carlos , Álvarez-Uría Ana , Bermejo Javier , Bouza Emilio , Caballero Gregorio Cuerpo , Montero Antonia Delgado , Mansilla Ana González , Leoni Mª Eugenia García , Gargallo Esther , Ramallo Víctor González , Hernández Martha Kestler , Hualde Amaia Mari , Machado Marina , Marín Mercedes , Martínez-Sellés Manuel , Muñoz Patricia , Olmedo María , Pedraz Álvaro , Pinilla Blanca , Pinto Ángel , Rincón Cristina , Rodríguez-Abella Hugo , Rodríguez-Créixems Marta , Segado Antonio , Toledo Neera , Valerio Maricela , Vázquez Pilar , Moreno Eduardo Verde , Antorrena Isabel , Loeches Belén , Moreno Mar , Ramírez Ulises , Bastón Verónica Rial , Romero María , Rosillo Sandra , Balbín Jesús Agüero , Amado Cristina , Castillo Carlos Armiñanzas , Arnaiz Ana , Revillas Francisco Arnaiz de las , Belaustegui Manuel Cobo , Fariñas María Carmen , Fariñas-Álvarez Concepción , Sampedro Marta Fernández , García Iván , Rico Claudia González , Gutierrez-Fernandez Laura , Gutiérrez-Cuadra Manuel , Díez José Gutiérrez , Pajarón Marcos , Parra José Antonio , Teira Ramón , Zarauza Jesús , Parra Jorge Calderón , Cobo Marta , Domínguez Fernando , Fortaleza Alberto , Pavía Pablo García , González Jesús , Cruz Ana Fernández , Múñez Elena , Ramos Antonio , Romero Isabel Sánchez , Centella Tomasa , Hermida José Manuel , Moya José Luis , Martín-Dávila Pilar , Navas Enrique , Oliva Enrique , del Río Alejandro , Stuart Jorge Rodríguez-Roda , Ruiz Soledad , Tenorio Carmen Hidalgo , Delia Manuel Almendro , Araji Omar , Barquero José Miguel , Jambrina Román Calvo , de Cueto Marina , Acebal Juan Gálvez , Méndez Irene , Morales Isabel , López-Cortés Luis Eduardo , de Alarcón Arístides , García Emilio , Haro Juan Luis , Lepe José Antonio , López Francisco , Luque Rafael , Alonso Luis Javier , Azcárate Pedro , Gutiérrez José Manuel Azcona , Blanco José Ramón , Villegas Antonio Cabrera , García-Álvarez Lara , García Concepción García , Oteo José Antonio , 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 , Blasco Andrés Canut , Mollar José Cordo , Arana Juan Carlos Gainzarain , Uriarte Oscar García , López Alejandro Martín , de Zárate Zuriñe Ortiz , Matos José Antonio Urturi , Antonio Sánchez-Porto , Alejandro Úbeda Iglesias , Leal José Mª Arribas , Vázquez Elisa García , Torres Alicia Hernández , Blázquez Ana , Valenzuela Gonzalo de la Morena , Alonso Ángel , Aramburu Javier , Calvo Felicitas Elena , Rodríguez Anai Moreno , Tarabini-Castellani Paola , Gálvez Eva Heredero , Bellido Carolina Maicas , Pau José Largo , Sepúlveda Mª Antonia , Sierra Pilar Toledano , Iqbal-Mirza Sadaf Zafar , Alcolea Eva Cascales , Yañez Ivan Keituqwa , Martínez Julián Navarro , Ballesta Ana Peláez , Escobar Eduardo Moreno , Monje Alejandro Peña , Cabrera Valme Sánchez , García David Vinuesa , Asenjo María Arrizabalaga , Luna Carmen Cifuentes , Morcillo Juana Núñez , Seco Mª Cruz Pérez , Gelabert Aroa Villoslada , Guallar Carmen Aured , Abad Nuria Fernández , Mangas Pilar García , Adell Marta Matamala , Ruiz Mª Pilar Palacián , Porres Juan Carlos , Vidal Begoña Alcaraz , Trigueros Nazaret Cobos , Espín María Jesús Del Amor , Caro José Antonio Giner , Sánchez Roberto Jiménez , Almazán Amaya Jimeno , Freire Alejandro Ortín , González Monserrat Viqueira , Ramis Pere Pericás , Blanco Mª Ángels Ribas , Bordes Enrique Ruiz de Gopegui , Bonet Laura Vidal , Munera Mª Carmen Bellón , Garaizabal Elena Escribano , Martínez Antonia Tercero , Luque Juan Carlos Segura , Badía Cristina , Palop Lucía Boix , Xercavins Mariona , Ibars Sónia , Bosch Xerach , Nebreda Eloy Gómez , Herrera Ibalia Horcajada , Gallego Irene Menduiña , Pulido Imanol , Santiago Héctor Marrero , Martínez Isabel de Miguel , Álamo Elena Pisos , Blanco Eva Mª Aguilar , González Mercedes Catalán , Peiretti María Angélica Corres , Esteve Andrea Eixerés , Pérez Laura Domínguez , Tejido Santiago de Cossío , Román Francisco Galván , Robles José Antonio García , Medrano Francisco López , Gude Mª Jesús López , Miguel Mª Ángeles Orellana , Pilkington Patrick , Ostalaza Yolanda Revilla , Morales Juan Ruiz , Solís Sebastián Ruiz , Collado Ana Sabín , Fernández Marcos Sánchez , Rallo Javier Solera , Martín Jorge Solís , Escrihuela-Vidal Francesc , Carratalà Jordi , Grau Inmaculada , Grillo Sara , Ardanuy Carmen , Berbel Dámaris , Salado José Carlos Sánchez , Alegre Oriol , Majoral Alejandro Ruiz , Sbraga Fabrizio , Blasco Arnau , Sánchez Laura Gracia , Sánchez-Rodríguez Iván , Álvarez Beatriz , Úbeda Alfonso Cabello , Roblas Ricardo Fernández , Lobato Miguel Ángel Navas , Pello Ana María , Cerón Ruth Esther Figueroa , Gómez Lara Ruiz , Ble Mireia , Gallego Juan Pablo Horcajada , Ginel Antonio José , López Inmaculada , Mas Alexandra , Mestres Antoni , Molina Lluís , Serrat Ramón , Ribas Núria , Sánchez Francisca , Silverio Ana , Suárez Marina , Sorlí Luisa , Recasens Lluís , Taurón Manuel 
Published: August 2022

Abstract

Background
Outpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used.

Methods
This was a prospective multicenter nationwide cohort study (2008–2018). Rates of readmission, recurrences, and 1-year mortality were compared between hospital-based antibiotic treatment (HBAT) and OPAT. Risk factors for readmission and mortality in OPAT patients were investigated by logistic regression. Patients did not fulfill OPAT-GAMES (Grupos de Apoyo al Manejo de la Endocarditis en ESpaña) criteria if they had any of the following: cirrhosis, severe central nervous system emboli, undrained abscesses, severe conditions requiring cardiac surgery in nonoperable patients, severe postsurgical complications, highly difficult-to-treat microorganisms, or intravenous drug use.

Results
A total of 2279 HBAT patients and 1268 OPAT patients were included. Among OPAT patients, 307 (24.2%) did not fulfill OPAT-GAMES criteria. Overall, OPAT patients presented higher rates of readmission than HBAT patients (18.2% vs 14.4%; P = .004), but no significant differences were found in the propensity analysis. Patients not fulfilling OPAT-GAMES criteria presented significantly higher rates of readmission than HBAT and OPAT-GAMES (23.8%, 14.4%, 16.4%; P &lt; .001), whereas no significant differences were found in mortality (5.9%, 8%, 7.4%; P = .103) or recurrences (3.9%, 3.1%, 2.5%; P = .546). Not fulfilling OPAT-GAMES criteria was associated with higher risk of readmission (odds ratio [OR], 1.43; 95% CI, 1.03–1.97; P = .03), whereas cardiac surgery was associated with lower risk (OR, 0.72; 95% CI, 0.53–0.98; P = .03).

Conclusions
OPAT-GAMES criteria allow identification of IE patients at higher risk of long-term complications to whom OPAT cannot be safely administered.