Suppressive antibiotic therapy for infectious endocarditis.

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• Infective endocarditis (IE) poses significant challenges, especially in patients unsuitable for surgery.
• Suppressive antibiotic therapy (SAT) offers a long-term management strategy for IE when definitive treatment is not possible.

Approach:

• A retrospective observational study was conducted at Strasbourg University Hospital (2020-2023).
• Medical files of patients receiving SAT for IE, as evaluated by the Multidisciplinary Endocarditis Team (MET), were reviewed.
• Primary endpoint: all-cause mortality; Secondary endpoints: 3/6-month mortality, relapse, and SAT tolerance.

Key Points:

• Twenty-two patients (9%) received SAT out of 251 evaluated.
• Patients were elderly (mean age 77.2 years) and highly comorbid (mean Charlson index 6.6).
• Indications for SAT included non-performable surgery or non-removable infected devices (20/22).
• Prosthetic valve IE (14 patients) and cardiac device IE (6 patients) were common.
• Staphylococcus aureus and enterococci were the most frequent pathogens (6/22 each).
• Mortality at follow-up was 23% (5/22), with rare tolerance issues (14%) and late relapses (10%).

Conclusions:

• SAT demonstrated low mortality and good tolerance in a cohort of elderly, comorbid IE patients.
• This therapy can be considered a palliative option when optimal surgical management or device removal is not feasible.