Barda Beatrice, Schindler Christian, Bernasconi Enos, Bongiovanni Marco
Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
J Clin Med. 2024 Dec 10;13(24):7518. doi: 10.3390/jcm13247518.
The treatment of infective endocarditis (IE) is based on long intravenous administration of antibiotics. This is still a hard-to-die dogma. Throughout the years, different researchers have attempted to demonstrate the safety and efficacy of an oral switch of the antibiotic regimen, with only scarce success. Nevertheless, in recent years, different reports have evaluated the efficacy of oral switch therapy in selected patients. Due to the lack of large trials, a meta-analysis could be useful to evaluate the potential benefits of early oral switch therapy not only in terms of microbiological cure but also in terms of relapse, mortality, and length of hospital stay (LOS). We conducted a Medline search, from which we were able to extrapolate 29 papers on IE treatment; the inclusion criteria were met by six papers only. Three trials were not randomized studies; therefore, we conducted the analysis both including and excluding the mentioned papers. Overall, we conducted our analysis on 840 patients who received intravenous treatment and 677 who received oral treatment. Our results confirmed that oral switch therapy represents an option in selected patients, with a reduction in the relapse rate (OR: 0.54, 95% CI: 0.31-0.92). No statistically significant differences were observed for treatment failure (OR: 0.74, 95% CI: 0.48-1.14), length of hospitalization (OR: -0.42, 95% CI: -1.55-0.71), complication rate (OR: 0.38, 95% CI: 0.1-1.54), and mortality (OR: 0.52, 95% CI: 0.22-1.22). Our results allow us to conclude that oral switch therapy is a feasible option in clinically stable patients with infective endocarditis. Moreover, oral switch therapy seems to perform significantly better than intravenous treatment in terms of relapse of infection. The data further support the implementation of oral switch therapy in infective endocarditis.
感染性心内膜炎（IE）的治疗基于长期静脉输注抗生素。这仍然是一个难以摒弃的教条。多年来，不同的研究人员试图证明抗生素治疗方案改为口服给药的安全性和有效性，但收效甚微。然而，近年来，不同的报告评估了口服转换疗法在特定患者中的疗效。由于缺乏大型试验，荟萃分析可能有助于评估早期口服转换疗法的潜在益处，不仅在微生物学治愈方面，而且在复发、死亡率和住院时间（LOS）方面。我们进行了一项医学文献检索，从中我们能够推断出29篇关于IE治疗的论文；只有6篇论文符合纳入标准。三项试验不是随机研究；因此，我们进行了分析，既纳入又排除上述论文。总体而言，我们对840名接受静脉治疗的患者和677名接受口服治疗的患者进行了分析。我们的结果证实，口服转换疗法是特定患者的一种选择，复发率降低（OR：0.54，95%CI：0.31 - 0.92）。在治疗失败（OR：0.74，95%CI：0.48 - 1.14）、住院时间（OR： - 0.42，95%CI： - 1.55 - 0.71）、并发症发生率（OR：0.38，95%CI：0.1 - 1.54）和死亡率（OR：0.52，95%CI：0.22 - 1.22）方面未观察到统计学上的显著差异。我们的结果使我们得出结论，口服转换疗法对于临床稳定的感染性心内膜炎患者是一种可行的选择。此外，在感染复发方面，口服转换疗法似乎比静脉治疗表现得明显更好。这些数据进一步支持在感染性心内膜炎中实施口服转换疗法。
