Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study.

Area of Science:

• Infectious Diseases
• Antimicrobial Therapy
• Clinical Outcomes Research

Background:

• Investigating the shift in antimicrobial therapy practices for infective endocarditis (IE).
• Comparing outcomes between intravenous-only and oral transitional therapy for IE.
• Evaluating a new practice implemented within the Los Angeles County Department of Health Services (LAC DHS).

Purpose of the Study:

• To compare clinical outcomes of patients with IE treated with intravenous-only versus oral transitional antimicrobial therapy.
• To assess the effectiveness and safety of oral transitional therapy as an alternative to prolonged intravenous therapy for IE.

Main Methods:

• Multicentered, retrospective cohort study.
• Inclusion of adult patients with definite or possible IE treated between December 2018 and June 2022.
• Primary outcome: clinical success at 90 days (alive, no recurrent bacteremia, no infectious complications).

Main Results:

• 257 patients included: 211 IV-only, 46 oral transitional.
• No significant difference in clinical success at 90 days or last follow-up between groups.
• Oral therapy group had significantly fewer adverse events; no difference in bacteremia recurrence or readmission.

Conclusions:

• Real-world data supports similar clinical outcomes for oral versus IV-only therapy in IE.
• Findings align with previous randomized controlled trials and meta-analyses.
• Oral transitional therapy represents a viable option for IE management with a potentially better safety profile.