Outpatient parenteral antimicrobial therapy for patients with Enterococcus faecalis endocarditis using continuous...

Many patients with Enterococcus faecalis endocarditis are clinically stable and able to leave hospital before completing antibiotic treatment, but data are lacking regarding some outpatient treatment options.

To assess the outcomes for adults with E. faecalis endocarditis receiving outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion IV benzylpenicillin plus bolus/continuous infusion IV ceftriaxone.

We retrospectively reviewed adults who received at least 2 weeks duration of OPAT for E. faecalis endocarditis with the above treatment regimen in the Auckland and Christchurch regions between July 2019 and September 2022.

Forty-four patients met inclusion criteria. Fifteen were female (34%). The median age was 80 (IQR 71.5 to 84) years. Twenty-two (50%) had prosthetic valve (PV), 15 (34%) native valve (NV), 3 (7%) NV and/or cardiac implantable electronic device (CIED) infection, 3 (7%) PV and/or CIED infection, and 1 (2%) repaired valve endocarditis. Patients received a median of 16.5 days inpatient and 28 days OPAT antibiotic treatment. The 12 month outcome was cure (n = 25; 57%), antibiotic suppression (n = 9; 20%), relapse (n = 2; 5%; both possible) or death (n = 8; 18%). Compared with a historical cohort treated with OPAT continuous infusion IV benzylpenicillin plus bolus IV gentamicin, there was no difference in the relapse rate.

This study adds to the accumulating evidence supporting the treatment of E. faecalis endocarditis with OPAT continuous infusion IV benzylpenicillin plus bolus/continuous infusion IV ceftriaxone. This is an option for patients requiring further antibiotic treatment at the time of hospital discharge.