The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Am Coll Cardiol. 2024 Dec 3;84(23):2293-2304. doi: 10.1016/j.jacc.2024.06.053.
The results from the POET (Partial Oral Treatment of left-sided Endocarditis) trial were published in August 2018 and established noninferiority of oral step-down antibiotic treatment in stabilized patients with infective endocarditis (IE). Data on length of hospital stay (LOS) and safety following the POET trial are warranted.
The goal of this study was to examine changes in LOS and safety (mortality and relapse of bacteremia) before and after POET publication.
Using Danish nationwide registries, patients with first-time IE caused by Streptococcus spp., Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci from 2012 to 2021 were identified. Median LOS was examined according to publication date (before and after September 2018). Mortality and relapse of bacteremia at 180 days of follow-up were examined.
We identified 3,008 patients before POET publication (median age 72.8 years) and 1,740 after publication (median age 75.2 years) (P < 0.0001). The median LOS decreased by 8 days: 41 days (Q1-Q3: 29-49 days) before POET publication and 33 days (Q1-Q3: 21-44 days) after POET publication (P < 0.0001). Similar reductions in LOS were seen across microbiological etiologies and age groups. Reduction in LOS was most pronounced in nonsurgically treated patients. Mortality from IE admission to a maximum of 180 days' follow-up was 27.5% before POET publication and 28.3% after publication (P = 0.41). The bacteremia relapse rate within 180 days was 3.5% before POET publication and 1.6% after publication (P = 0.0002).
Following the POET trial, we found a reduction in median LOS of 8 days with no change in mortality and an associated lower rate of relapse of bacteremia.
POET（左侧心内膜炎的部分口服治疗）试验的结果于 2018 年 8 月公布，证实了对于感染性心内膜炎（IE）稳定患者，口服降阶梯抗生素治疗具有非劣效性。需要 POET 试验后的数据来评估住院时间（LOS）和安全性。
本研究的目的是检验 POET 公布前后 LOS 和安全性（死亡率和菌血症复发）的变化。
使用丹麦全国性登记处，确定了 2012 年至 2021 年间由链球菌、粪肠球菌、金黄色葡萄球菌或凝固酶阴性葡萄球菌引起的首次 IE 患者。根据发表日期（POET 之前和之后）检查中位 LOS。在随访的 180 天内，检查死亡率和菌血症复发。
在 POET 公布之前，我们确定了 3008 名患者（中位年龄 72.8 岁），公布之后确定了 1740 名患者（中位年龄 75.2 岁）（P＜0.0001）。LOS 中位数降低了 8 天：POET 公布前为 41 天（Q1-Q3：29-49 天），公布后为 33 天（Q1-Q3：21-44 天）（P＜0.0001）。在不同的微生物病因和年龄组中，LOS 都有类似的降低。在非手术治疗的患者中，LOS 降低最为显著。POET 公布前 IE 入院至最多 180 天的死亡率为 27.5%，公布后为 28.3%（P=0.41）。POET 公布前 180 天内菌血症复发率为 3.5%，公布后为 1.6%（P=0.0002）。
POET 试验后，我们发现中位 LOS 降低了 8 天，死亡率没有变化，且菌血症复发率较低。
