Ashraf Hamza, Nadeem Zain Ali, Rehman Khawaja Abdul, Akhtar Shanzay, Ashfaq Haider, Khan Muhammad Sohaib, Butt Mahad, Nagmeldin Ibrahim, Fatima Eeshal, Waqas Muhammad, Saleh Aalaa, Jain Hritvik, Ahmed Raheel
Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Department of Medicine, CMH Lahore Medical College, Lahore, Pakistan.
Clin Cardiol. 2025 May;48(5):e70147. doi: 10.1002/clc.70147.
Infective endocarditis (IE) is a life-threatening infection requiring prolonged intravenous antimicrobial therapy. Outpatient parenteral antibiotic therapy (OPAT) has emerged as an alternative to prolonged hospitalization, but its safety and efficacy in IE remain debated.
This systematic review and meta-analysis aimed to evaluate the outcomes of OPAT in IE patients.
We systematically searched MEDLINE, Cochrane CENTRAL, Google Scholar, and Scopus for studies assessing OPAT in IE. Eligible studies included randomized controlled trials and observational studies reporting at least one relevant outcome (mortality, relapse, readmission, valve surgery, and adverse events). Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. Risk of bias was evaluated using the ROBINS-I tool.
A total of 25 studies involving 2654 patients were included in the analysis. Patients treated with OPAT had a mortality rate of 0% during the treatment period and 5% during follow-up. The readmission rate was 16% during the treatment period, 4% of the patients had relapse, while 16% of patients underwent cardiac surgery. During follow-up, the readmission rate was 19%, with a relapse rate of 2%, and 14% of patients underwent cardiac surgery. Sensitivity analyses did not significantly affect the results, highlighting the robustness of the findings.
OPAT appears to be safe and effective for IE patients, with low mortality and relapse rates. However, increased readmission rates and IV-line complications warrant careful patient selection and monitoring. Further prospective trials are needed to refine OPAT protocols.
感染性心内膜炎（IE）是一种危及生命的感染，需要长期静脉应用抗菌药物治疗。门诊胃肠外抗生素治疗（OPAT）已成为长期住院的替代方案，但其在IE中的安全性和有效性仍存在争议。
本系统评价和荟萃分析旨在评估OPAT治疗IE患者的结局。
我们系统检索了MEDLINE、Cochrane CENTRAL、谷歌学术和Scopus，以查找评估OPAT治疗IE的研究。符合条件的研究包括随机对照试验和观察性研究，报告至少一项相关结局（死亡率、复发、再入院、瓣膜手术和不良事件）。采用随机效应模型计算合并估计值，并使用I²统计量评估异质性。使用ROBINS-I工具评估偏倚风险。
共有25项研究涉及2654例患者纳入分析。接受OPAT治疗的患者在治疗期间死亡率为0%，随访期间为5%。治疗期间再入院率为16%，4%的患者复发，16%的患者接受了心脏手术。随访期间，再入院率为19%，复发率为2%，14%的患者接受了心脏手术。敏感性分析未显著影响结果，突出了研究结果的稳健性。
OPAT对IE患者似乎是安全有效的，死亡率和复发率较低。然而，再入院率增加和静脉置管并发症需要仔细选择患者并进行监测。需要进一步的前瞻性试验来完善OPAT方案。
