Key result
Suppressive antimicrobial treatment discontinuation in non-surgical patients with prosthetic valve endocarditis was not associated with an increased risk of relapse (HR 0.97; 95% CI 0.21-4.4; P=0.98).
Why the study?
The study aimed to characterize suppressive antimicrobial treatment (SAT) for non-surgical candidate patients with prosthetic valve endocarditis.
Does suppressive antimicrobial treatment prevent relapse and death in non-surgical candidate patients with prosthetic valve endocarditis?
Systematic Review (n=170)
Does suppressive antimicrobial treatment prevent relapse and death in non-surgical candidate patients with prosthetic valve endocarditis?
Hazard Ratio: 0.97 (95% CI 0.21–4.4)
p-value: p=0.98
Suppressive antimicrobial treatment in non-surgical patients with prosthetic valve endocarditis is supported only by low-quality evidence, with a 15.57% mortality rate and 8.92% relapse rate, highlighting the need for further evaluation.
OBJECTIVES: We aimed to characterize suppressive antimicrobial treatment (SAT) for non-surgical candidate patients with prosthetic valve endocarditis (PVE). METHODS: of June 2024. The review protocol was registered on PROSPERO database [CRD42024529650]. RESULTS: One hundred seventy patients were retrieved from 91 studies. PVE-related death during follow-up occurred in 26 (15.57%) patients, being associated with coagulase-negative staphylococci PVE in multivariate Cox regression model (HR 3.40, 95% CI 1.06-10.97, P-value = 0.04). Relapse occurred in 15 (8.92%) patients and was similar according to SAT discontinuation (long-rank test P-value = 0.8). This was confirmed after performing landmark analysis to adjust for survival bias (HR 0.97; 95% CI 0.21-4.4, P-value = 0.98). SAT-related adverse events were reported in 15% of the patients. CONCLUSION: Supporting evidence for SAT is low and derived from case reports and case series. SAT seems well tolerated, but clinical effectiveness should be further evaluated due to the relevant mortality rate. In selected cases when SAT discontinuation is considered, close and long-term follow-up is crucial to prevent relapse.
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Valsecchi et al. (2025) conducted a systematic review in Prosthetic valve endocarditis (PVE) (n=170). Suppressive antimicrobial treatment (SAT) discontinuation vs. SAT continuation was evaluated on Relapse (HR 0.97, 95% CI 0.21-4.4, p=0.98). Suppressive antimicrobial treatment discontinuation in non-surgical patients with prosthetic valve endocarditis was not associated with an increased risk of relapse (HR 0.97; 95% CI 0.21-4.4; P=0.98).
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