Management of endocarditis: outpatient parenteral antibiotic treatment in Argentina.

Patients with infective endocarditis often face lengthy hospitalization for parenteral antibiotic therapy. Efforts to reduce medical costs have led to consideration of outpatient parenteral antibiotic treatment (OPAT) for these patients. However, concerns about outpatient management of complications, particularly congestive heart failure and emboli, exist. In Argentina, carefully selected patients with infective endocarditis, representing a low-risk population, have been successfully treated with OPAT. A retrospective analysis was conducted of 48 such patients. Three delivery models were used: at home with medications given by the visiting nurse, at infusion center, or at home with medications self-administered. Ten patients received OPAT only; 38 were initially hospitalized, then transferred to an OPAT program. Twenty-nine patients had streptococcal disease, 37 out of 48 patients were treated with ceftriaxone. Clinical and microbiologic cure was achieved in all patients. Three patients developed heart failure, 2 prior to starting antibiotic therapy. Four developed emboli, all prior to starting antibiotics. Surgery was required in 5 patients: 2 were treated with OPAT postoperatively and 3 had surgery after antibiotic therapy was completed. OPAT for infective endocarditis is safe in well selected patients.