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

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

Autores: 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

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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.

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