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Suppressive antibiotic therapy for infectious endocarditis.

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Suppressive antibiotic therapy (SAT) for infective endocarditis (IE) is a viable option when surgery is not feasible. This approach showed low mortality and rare tolerance issues in elderly, comorbid patients.

Keywords:
Cardiac implantable electronic device infectionInfectious endocarditisProsthetic valve endocarditisSuppressive antibiotic therapy

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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.