POET: Switch to oral antibiotics confers better outcomes in left-sided endocarditis
NEW ORLEANS — In long-term follow-up of patients with left-sided endocarditis, those who were switched from IV antibiotics to oral antibiotics after stabilization had better rates of survival and other outcomes, according to new data from the POET trial.
As Cardiology Today previously reported, among patients in stabilized condition with left-sided infective endocarditis caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus or coagulase-negative staphylococci who were on IV antibiotics for at least 10 days, those who were randomly assigned to switch to oral antibiotics had similar 6-month outcomes to those who were assigned to stay on IV antibiotics, and the group that was switched had a shorter hospital stay (3 days vs. 19 days after randomization).
Oral treatment included two antibiotics in all cases, chosen according to careful susceptibility testing.
For the present analysis, presented at the American College of Cardiology Scientific Session by Henning Bundgaard, MD, DMSc, from the department of cardiology, the Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark, and published as a research letter in The New England Journal of Medicine, the researchers analyzed the 400-patient cohort after a median follow-up of 3.5 years.
The primary outcome was a composite of all-cause mortality, unplanned cardiac surgery, embolic events or relapse of bacteremia with the primary pathogen. No patients were lost to follow-up.
During the study period, the oral group had reduced risk for the primary outcome compared with the IV group (26.4% vs. 38.2%; HR = 0.64; 95% CI, 0.45-0.91), according to the researchers.
Mortality was also lower in the oral group (16.4% vs. 27.1%; HR = 0.57; 95% CI, 0.37-0.87) and differences in the other three components of the primary outcome were not significant between the groups, Bundgaard said.
“The favorable outcome in the oral group was not related to the administration of antibiotics,” Bundgaard said during a discussion after his presentation. “It’s fair to say that short term and long term, there were no differences in [patients who did not respond to antibiotics] between the two groups. So, I don’t think the results related to the different ways of administration. The major difference between the two groups was that the intravenously treated patients stayed in the hospital for more than 2 weeks longer than the orally treated patients. We all know that staying in the hospital may cause physical as well as mental losses. These patients’ capacities are reduced, and they are quite often elderly and sick with comorbidities. So, maybe they don’t ever recover from their losses after their prolonged hospital stays. This will increase vulnerability and make the patients at higher risk of a negative outcome when struck by another disease, such as heart failure, infection or cancer.”
The mean age of the patients in both groups was 67 years. The oral group consisted of 21% women, whereas the IV group consisted of 25% women. – by Erik Swain
Bundgaard H, et al. Joint American College of Cardiology/Journal of the American Medical Association Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.
Disclosure: Bundgaard reports no relevant financial disclosures.