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Antibiotic therapy for Endocarditis in Outpatient setting: is it ineffective and safe in low risk patients?
Session:
SESSÃO DE POSTERS 15 - ENDOCARDITE INFECIOSA 2
Speaker:
Lucas Hamann
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.4 Infective Endocarditis – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Lucas Hamann; Sofia Andraz; Joana Guerreiro Pereira; Joana Massa Pereira; Miguel Espirito Santo; Hugo Costa; Pedro De Azevedo; Raquel Fernandes; Dina Bento; Daniela Silva; João Moura Guedes; Jorge Mimoso
Abstract
<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Endocarditis remains a challenging condition requiring prolonged treatment. Outpatient antibiotic therapy (OAT), including parenteral (OPAT) or oral (OOAT) regimens, has emerged as a safe, cost-effective alternative to hospital-based antibiotic therapy (HBAT) for low-risk patients. However, the lack of standardized criteria and safety concerns complicates patient selection for OAT.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Objective:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To compare OAT and HBAT patients regarding baseline characteristics, mortality over 2 years (primary outcome), and secondary outcomes such as causes of death, re-hospitalization, and re-operation.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">This retrospective study (2020–2024) included 36 patients diagnosed with endocarditis, divided into OAT (n=20) and HBAT (n=16) groups. Baseline characteristics, comorbidities, and outcomes were analyzed. Data were presented as frequencies and percentages or means and standard deviations. Logistic regression was used, with p<0.05 considered significant.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The mean age was 58±16 years, and 67% of patients were male. Among OAT patients, 75% received OPAT and 25% OOAT. Comorbidities included heart failure (10%), hypertension (55%), diabetes (45%), obesity (15%), HIV infection (10%), intravenous drug use (15%), and cancer (25%). No significant differences were observed between groups in comorbidities, infection site, valvular surgery, complications, or cardiovascular device presence. Mortality rates during the follow-up (19.8±16.8 months) were comparable (HBAT: 44% vs. OAT: 15%, p=0.829), with no significant differences in first-year mortality. However, OAT significantly reduced re-hospitalization rates (HBAT: 50% vs. OAT: 15%, p=0.023) and showed differing causes of death, though re-operation rates were similar.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">When guided by appropriate clinical judgment, OAT is as effective as HBAT in terms of mortality while reducing hospital burden and re-hospitalization rates. OAT represents a viable option for select endocarditis patients, emphasizing the need for standardized patient selection criteria.</span></span></span></p> <p> </p>
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