Association Between Vegetation Size and Outcome in the Partial Oral Antibiotic Endocarditis Treatment Trial

Rasmus Carter-Storch*, Mia Marie Pries-Heje, Jonas A Povlsen, Ulrik Christensen, Sabine U Gill, Julie Glud Hjulmand, Niels E Bruun, Hanne Elming, Trine Madsen, Kurt Fuursted, Martin Schultz, Jens J Christensen, Flemming Rosenvinge, Jannik Helweg-Larsen, Emil Fosbøl, Lars Køber, Christian Torp-Pedersen, Niels Tønder, Claus Moser, Kasper IversenHenning Bundgaard, Nikolaj Ihlemann

*Corresponding author af dette arbejde

Abstract

Step-down oral antibiotic therapy is associated with a non-inferior long-term outcome compared with continued intravenous antibiotic therapy in the treatment of left-sided infective endocarditis. We aimed to analyze whether step-down oral therapy compared with continued intravenous antibiotic therapy is also associated with a non-inferior outcome in patients with large vegetations (vegetation length ≥ 10 mm) or among patients who underwent surgery before step-down oral therapy. We included patients without presence of aortic root abscess at diagnosis from the POET (Partial Oral Antibiotic Endocarditis Treatment) study. Multivariable Cox regression analyses were used to find associations between large vegetation, cardiac surgery, step-down oral therapy, and the primary end point (composite of all-cause mortality, unplanned cardiac surgery, embolic event, or relapse of positive blood cultures during follow-up). A total of 368 patients (age 68 ± 12, 77% men) were included. Patients with large vegetations (n = 124) were more likely to undergo surgery compared with patients with small vegetations (n = 244) (65% vs 20%, p <0.001). During a median 1,406 days of follow-up, 146 patients reached the primary end point. Large vegetations were not associated with the primary end point (hazard ratio 0.74, 95% confidence interval 0.47 to 1.18, p = 0.21). Step-down oral therapy was non-inferior to continued intravenous antibiotic in all subgroups when stratified by the presence of a large vegetation at baseline and early cardiac surgery. Step-down oral therapy is safe in the presence of a large vegetation at diagnosis and among patients who underwent early cardiac surgery.

OriginalsprogEngelsk
TidsskriftThe American journal of cardiology
Vol/bind222
Sider (fra-til)131-140
Antal sider10
ISSN0002-9149
DOI
StatusUdgivet - 2024

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