Management of Infective Endocarditis in Outpatients: Clinical Experience with Outpatient Parenteral Antibiotic Therapy

BACKGROUND: There is limited experience in treating infective endocarditis (IE) with outpatient parenteral antibiotic therapy (OPAT). METHODS: Following institutional review board (IRB) approval, patients discharged from Baystate Medical Center with IE documented by modified Duke criteria treated with OPAT were identified. Data obtained included organisms implicated, indications of clinical stability, percentage of total therapy rendered after hospitalization, and one year follow up. RESULTS: Forty-three patients met criteria. Thirty-five percent were infected with staphylococci; 38% harbored streptococci or enterococci. Native valves and left-sided valves each constituted approximately 75% of total. All patients received >4 weeks of therapy, with >66% rendered after hospital discharge A median of 7 days of hemodynamic stability and negative blood cultures occurred prior to discharge. After one year, no patients died from IE. Twenty-three percent were hospitalized during OPAT from intravenous catheter, antibiotic, or other complications, but none for direct complications of IE. CONCLUSIONS: OPAT for IE can be safely utilized, and at least 66% of care can be given in this manner. Our investigation provides enhanced data on employing OPAT for IE caused by staphylococci, left-sided infections, and also provides outcomes after one year after treatment.