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This work was supported by the Ministerio de Sanidad y Consumo of Spain (FIS PI19/0898 granted to J.M.P.) and Institut d'Investigacions Biomediques Pi i Sunyer (IDIBAPS) provided to J.M.M. as a personal 80:20 research grant during 2017-2023.

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Ramos-Martinez, AntonioAuthor

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July 3, 2023
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Outpatient Parenteral Antibiotic Treatment vs Hospitalization for Infective Endocarditis: Validation of the OPAT-GAMES Criteria

Publicated to:Open Forum Infectious Diseases. 9 (9): ofac442- - 2022-09-02 9(9), DOI: 10.1093/ofid/ofac442

Authors: Pericas, Juan M.; Llopis, Jaume; Munoz, Patricia; Gonzalez-Ramallo, Victor; Eugenia Garcia-Leoni, M.; de Alarcon, Aristides; Luque, Rafael; Farinas, M. Carmen; Goenaga, Miguel A.; Hernandez-Meneses, Marta; Nicolas, David; Ramos-Martinez, Antonio; Rodriguez-Esteban, M. Angeles; Villoslada-Gelabert, Aroa; Miro, Jose M.;GAMES Investigators

Affiliations

Hosp Cent Asturias, Serv Med Intens, Oviedo, Spain - Author
Hosp Donostia, San Sebastian, Spain - Author
Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon, CIBER Enfermedades Resp CIBERES CB06 06 0058, Madrid, Spain - Author
Hosp Son Llatzer, Serv Med Interna Enfermedades Infecciosas, Palma De Mallorca, Balearic Island, Spain - Author
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain - Author
Univ Barcelona, Dept Genet Microbiol & Stat, Barcelona, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, Inst Recerca Augusti Pi i Sunyer, Barcelona, Spain - Author
Univ Cantabria, Hosp Univ Marques Valdecilla, Santander, Spain - Author
Univ Puerta Hierro, Serv Med Interna, Unidad Enfermedades Infecciosas, Madrid, Spain - Author
Univ Seville, Inst Biomed Seville IBIS, Microbiol & Prevent Med Infect Dis Res Grp, Clin Unit Infect Dis,CSIC,Univ Virgen Rock & Virg, Seville, Spain - Author
Vall dHebron Univ Hosp, Vall dHebron Inst Res, Internal Med Dept, Liver Unit,CIBER Enfermedades Hepat & Digest CIBE, Barcelona, Spain - Author
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Abstract

Background Outpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used. Methods This was a prospective multicenter nationwide cohort study (2008-2018). Rates of readmission, recurrences, and 1-year mortality were compared between hospital-based antibiotic treatment (HBAT) and OPAT. Risk factors for readmission and mortality in OPAT patients were investigated by logistic regression. Patients did not fulfill OPAT-GAMES (Grupos de Apoyo al Manejo de la Endocarditis en ESpana) criteria if they had any of the following: cirrhosis, severe central nervous system emboli, undrained abscesses, severe conditions requiring cardiac surgery in nonoperable patients, severe postsurgical complications, highly difficult-to-treat microorganisms, or intravenous drug use. Results A total of 2279 HBAT patients and 1268 OPAT patients were included. Among OPAT patients, 307 (24.2%) did not fulfill OPAT-GAMES criteria. Overall, OPAT patients presented higher rates of readmission than HBAT patients (18.2% vs 14.4%; P = .004), but no significant differences were found in the propensity analysis. Patients not fulfilling OPAT-GAMES criteria presented significantly higher rates of readmission than HBAT and OPAT-GAMES (23.8%, 14.4%, 16.4%; P < .001), whereas no significant differences were found in mortality (5.9%, 8%, 7.4%; P = .103) or recurrences (3.9%, 3.1%, 2.5%; P = .546). Not fulfilling OPAT-GAMES criteria was associated with higher risk of readmission (odds ratio [OR], 1.43; 95% CI, 1.03-1.97; P = .03), whereas cardiac surgery was associated with lower risk (OR, 0.72; 95% CI, 0.53-0.98; P = .03). Conclusions OPAT-GAMES criteria allow identification of IE patients at higher risk of long-term complications to whom OPAT cannot be safely administered.

Keywords

infective endocarditismortalityoutpatient parenteral antibiotic treatmentreadmissionAntimicrobial therapyClinical presentationDiagnosisEpidemiologyEtiologyExperienceGuidelinesInfective endocarditisManagementMortalityOutpatient parenteral antibiotic treatmentReadmissionRecurrencesSafeStatement

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Open Forum Infectious Diseases due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Infectious Diseases.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.36. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 4.96 (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-02, the following number of citations:

  • WoS: 6
  • Europe PMC: 4

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-02:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 32.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 35 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 10.1.
  • The number of mentions on the social network X (formerly Twitter): 7 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.