Treatment of left-sided prosthetic valve endocarditis by suppressive antibiotic therapy: A retrospective monocentric...

Prosthetic valve endocarditis has a poor prognosis, with high risks of relapse complicating management. Suppressive antibiotic therapy is increasingly considered as a means of treatment for infected devices that cannot be removed. We compared i) early mortality and ii) one-year overall and relapse-free survival between different strategies in real-world management of prosthetic valve endocarditis, one of them being suppressive antibiotic therapy.

This single-center retrospective study included patients with aortic or mitral prosthetic valve endocarditis managed between 2019 and 2021. Each strategy was patient-centered and decided on by a multidisciplinary team. At first, we divided the population between surgically and conservatively managed patients. Initial intravenous antibiotic therapy lasted at least six weeks, and we compared early mortality having occurred prior to its completion. At a later stage, we divided the conservatively managed survivors between those who received suppressive antibiotic therapy and those who did not, and we compared survival and relapse rates during the first year subsequent to adaptation of each strategy.

Seventy-five patients were included. Biological prostheses (33 %) for aortic valve replacement (95 %) predominated. The 17 (22.3 %) surgically managed patients were younger. Among the 58 conservatively managed patients, 42 had a theoretical indication for surgery. Eleven (14.6 %) patients died before having completed their course of intravenous antibiotic therapy, with no difference between surgical and conservative strategies (17.6 % vs. 13.8 %, p = 0.7043). Out of the 50 conservatively managed survivors, 35 received suppressive antibiotic therapy. Overall one-year survival was 73.9 % [64.1-85.2] and did not differ from one strategy to the next. Only six relapses occurred within the first year, including one (7.1 %) in surgically managed survivors and two (5.6 %) among the conservatively managed survivors receiving suppressive antibiotic therapy (5.6 %).

While surgery remains the gold standard for prosthetic valve endocarditis, especially in complicated cases, suppressive antibiotic therapy appeared suitable for selected patients for whom the surgical option seemed excessively risky.