Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander.
Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander.
Clin Infect Dis. 2019 Oct 30;69(10):1690-1700. doi: 10.1093/cid/ciz030.
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).
Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed.
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.
OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
门诊静脉用抗生素治疗（OPAT）已被证明对治疗感染性心内膜炎（IE）有效。然而，2001 年美国感染病学会（IDSA）IE 中 OPAT 的标准非常严格。我们旨在比较 OPAT 与住院抗生素治疗（HBAT）的结局。
对 25 家西班牙医院的 2000 例连续 IE 患者的多中心前瞻性队列研究数据进行回顾性分析（2008-2012 年）。
共有 429 例（21.5%）患者接受了 OPAT，只有 21.7%符合 IDSA 标准。男性占 70.5%，中位年龄为 68 岁（四分位距[IQR]，56-76），57%为原发性瓣膜 IE。最常见的病原体为草绿色链球菌（18.6%）、金黄色葡萄球菌（15.6%）和凝固酶阴性葡萄球菌（14.5%）。抗生素治疗的中位时间为 42 天（IQR，32-54），44%的患者接受了心脏手术。1 年死亡率为 8%（HBAT 为 42%；P<0.001），1.4%的患者复发，出院后 3 个月内再入院率为 10.9%（与 HBAT 相比无显著差异）。Charlson 评分（比值比[OR]，1.21；95%置信区间[CI]，1.04-1.42；P=0.01）和心脏手术（OR，0.24；95%CI，0.09-.63；P=0.04）与 1 年死亡率相关，而主动脉瓣受累（OR，0.47；95%CI，0.22-.98；P=0.007）是 1 年再入院的唯一预测因素。未满足 IDSA 标准不是死亡或再入院的危险因素。
尽管使用的标准比 IDSA 推荐的标准更广泛，但 OPAT 仍取得了优异的结果。因此，OPAT 的标准应予以扩大。
