Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand.
Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand.
Int J Infect Dis. 2023 Sep;134:172-176. doi: 10.1016/j.ijid.2023.06.008. Epub 2023 Jun 16.
We examined the safety and clinical outcomes of outpatient parenteral antibiotic therapy (OPAT) for patients with infective endocarditis (IE) in Christchurch, New Zealand.
Demographic and clinical data were collected from all adult patients treated for IE over 5 years. Outcomes were stratified by receipt of at least partial OPAT vs entirely hospital-based parenteral therapy.
There were 172 episodes of IE between 2014 and 2018. OPAT was administered in 115 cases (67%) for a median of 27 days after a median of 12 days of inpatient treatment. In the OPAT cohort, viridans group streptococci were the commonest causative pathogens (35%) followed by Staphylococcus aureus (25%) and Enterococcus faecalis (11%). There were six (5%) antibiotic-related adverse events and 26 (23%) readmissions in the OPAT treatment group. Mortality in OPAT patients was 6% (7/115) at 6 months and 10% (11/114) at 1 year and for patients receiving wholly inpatient parenteral therapy was 56% (31/56) and 58% (33/56), respectively. Three patients (3%) in the OPAT group had a relapse of IE during the 1-year follow-up period.
OPAT can be used safely in patients with IE, even in selected cases with complicated or difficult-to-treat infections.
我们研究了新西兰克赖斯特彻奇（Christchurch）门诊患者接受抗生素治疗（OPAT）的安全性和临床结局。
从所有接受 IE 治疗的成年患者中收集 5 年的数据。根据是否接受至少部分 OPAT 治疗与完全基于医院的静脉内治疗，对结果进行分层。
2014 年至 2018 年期间共发生 172 例 IE。115 例（67%）患者接受了 OPAT，中位治疗时间为 27 天，住院治疗的中位时间为 12 天。在 OPAT 组中，草绿色链球菌是最常见的病原体（35%），其次是金黄色葡萄球菌（25%）和粪肠球菌（11%）。在 OPAT 治疗组中，有 6 例（5%）与抗生素相关的不良事件和 26 例（23%）再入院。OPAT 患者在 6 个月时的死亡率为 6%（7/115），1 年时的死亡率为 10%（11/114），而接受完全基于医院的静脉内治疗的患者在 6 个月时的死亡率为 56%（31/56），1 年时的死亡率为 58%（33/56）。在 OPAT 组中有 3 例（3%）患者在 1 年随访期间出现 IE 复发。
即使在治疗复杂或难以治疗的感染的情况下，OPAT 也可以安全地用于 IE 患者。
