Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis

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Abstract

Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown.

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Most cited references 15

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Systematic review of enhanced recovery programmes in colonic surgery.

J. Wind, S Polle, P. H. P. Fung Kon Jin … (2006)

Fast track (FT) programmes optimize perioperative care in an attempt to accelerate recovery, reduce morbidity and shorten hospital stay. The aim of this review was to assess FT programmes for elective segmental colonic resections. A systematic review was performed of all randomized controlled trials and controlled clinical trials on FT colonic surgery. The main endpoints were number of applied FT elements, hospital stay, readmission rate, morbidity and mortality. Quality assessment and data extraction were performed independently by three observers. Six papers were eligible for analysis (three randomized controlled and three controlled clinical trials), including 512 patients. FT programmes contained a mean of nine (range four to 12) of the 17 FT elements as defined in the literature. Primary hospital stay (weighted mean difference - 1.56 days, 95 per cent confidence interval (c.i.) - 2.61 to - 0.50 days) and morbidity (relative risk 0.54, 95 per cent c.i. 0.42 to 0.69) were significantly lower for FT programmes. Readmission rates were not significantly different (relative risk 1.17, 95 per cent c.i. 0.73 to 1.86). No increase in mortality was found. FT appears to be safe and shortens hospital stay after elective colorectal surgery. However, as the evidence is limited, a multicentre randomized trial seems justified. Copyright 2006 British Journal of Surgery Society Ltd.

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A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer.

Chun Khoo, Christopher J Vickery, Nicola Forsyth … (2007)

A prospective randomized controlled trial (RCT) of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. This study evaluates the use of a multimodal package in colorectal cancer surgery in the context of an RCT. Patients for elective resection for colorectal cancer were offered trial entry. Participants were stratified by sex and requirement for a total mesorectal excision and centrally randomized. Multimodal patients received intravenous fluid restriction, unrestricted oral intake with prokinetic agents, early ambulation, and fixed regimen epidural analgesia. Control patients received intravenous fluids to prevent oliguria, restricted oral intake until return of bowel motility, and weaning regimen epidural analgesia. Adherence to both regimens was reinforced using a daily checklist and protocol guidance sheets. Discharge decision was made using pre-agreed criteria. The primary endpoint was postoperative stay, and achievement of independence milestones. Secondary endpoints were postoperative complications, readmission rates, and mortality. Analysis was by intention to treat. Seventy patients were recruited. Approximately one fourth underwent TME. Median ages were similar (69.3 vs. 73.0 years). The median stay was significantly reduced in the multimodal group (5 vs. 7 days; P < 0.001, Mann-Whitney U test). Patients in the control arm were 2.5 times as likely to require a postoperative stay of more than 5 days. Patients in the multimodal group had less cardiorespiratory and anastomotic complications but more readmissions. There were 2 deaths, both controls. This RCT provides level 1b evidence that a multimodal management protocol can significantly reduce postoperative stay following colorectal cancer surgery. Morbidity and mortality are not increased.

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Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size.

M Mena, Jesus Fortun, Carmen Quereda … (2005)

Native valve endocarditis in drug-user patients had a microbiology, a frequency of involvement of different cardiac valves, and a prognosis that differ from those in non-drug users. A retrospective study of native valve endocarditis cases in intravenous drug users diagnosed from 1985 to 1999 in our institution was performed to analyze the inhospital mortality of drug users with native valve endocarditis and to identify factors predictive of mortality. All patients fulfilled the Duke's criteria for definite or probable endocarditis. Analysis of predictors of inhospital mortality was restricted to right-sided infective endocarditis (IE) with definite diagnosis and echocardiographic data. The following variables were analyzed: sex, HIV serostatus, CD4 cell count 2 cm, and inhospital cardiac surgery. Logistic regression was used in a multivariate model to identify factors independently associated with mortality. Adjusted odds ratios (OR) and 95% CIs were examined. Four hundred ninety-three cases of IE were diagnosed in this period. Two hundred twenty cases of native valve endocarditis in intravenous drug users were identified. Fourteen cases in this group died (6%). Mean time from diagnosis to death was 18.5 +/- 15 days (range, 3-52). Vegetation size was available in 111 cases. Univariate analysis identified the following variables associated with inhospital mortality in right-sided cases: VS > 2 cm and fungal etiology. In multivariate analysis, the variables associated with mortality that achieved statistical significance were size of vegetation > 2 cm (P = .014, OR 10.2, 95% CI 1.6-78.0) and fungal etiology (P = .009, OR 46.2, 95% CI 2.4-1100.9). The main prognostic factors of inhospital mortality in right-sided IE in drug users in our series were VS > 2 cm and fungal etiology. The role of early surgery in these patients should be reevaluated.

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Author and article information

Journal

Title: New England Journal of Medicine

Abbreviated Title: N Engl J Med

Publisher: New England Journal of Medicine (NEJM/MMS)

ISSN (Print): 0028-4793

ISSN (Electronic): 1533-4406

Publication date Created: August 28 2018

Publication date (Electronic): August 28 2018

Affiliations

[1 ]From the Department of Cardiology, Herlev-Gentofte University Hospital (K.I., M.S., C.F.K.), Department of Cardiology, the Heart Center, Rigshospitalet, Copenhagen University Hospital (N.I., D.E.H., E.L.F., L.K., H.B.), the Departments of Infectious Diseases (J.H.-L.) and Clinical Microbiology (C.M.), Rigshospitalet, the Department of Cardiology, Hillerød Hospital (N.T.), and the Department of Clinical Microbiology, Slagelse Hospital and Institute of Clinical Medicine (J.J.C.), University of Copenhagen,...

Article

DOI: 10.1056/NEJMoa1808312

PubMed ID: 30152252

SO-VID: 91037aeb-0105-40d4-8ff6-a361c545f9d8

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http://www.nejmgroup.org/legal/terms-of-use.htm

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Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis

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Most cited references 15

Systematic review of enhanced recovery programmes in colonic surgery.

A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer.

Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size.

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Cited by 239