Should We Extend the Use of Oral Antibiotics in Infective Endocarditis? The ENDO-ORAL Study

Abstract

Background: Switching to oral therapy has become an option for treating infective endocarditis (IE) in well-selected patients. This study aimed to assess its effectiveness in real-life settings, including patients who would not have been eligible under current guidelines based on the POET trial results.

Methods: All adults treated for IE in two French tertiary centers from January 2016 to December 2023 were included in a retrospective cohort. For each participant, clinical, microbiological, and therapeutic data were collected retrospectively. Patients who received at least 10 days of effective antibiotic therapy were included and categorized based on the route of administration (exclusively intravenous or with a switch to oral therapy). POET-ineligible patients were those who were not eligible in the POET trial. Treatment failure (death, recurrence, or need for suppressive therapy, within 3 months following completion of the initial antibiotic course) was assessed using propensity score (PS) analysis, with oral switch as a time-dependent variable.

Results: Three hundred and thirty-three participants were included (233 in the intravenous group and 100 patients in the oral group). No significant difference in treatment failure was observed between groups after adjustment using a PS (HR = 0.55 in favor of oral switch, 95% CI = .27-1.17). The results were similar in the POET-ineligible subgroup, which accounted for 44.7% of participants. Days alive outside the hospital were significantly higher in the oral group (59 vs 47 days, P = .001).

Conclusions: Oral switch is a suitable option beyond "classical" frontiers in the management of IE, with potential direct and indirect benefits.

Keywords: cohort; infective endocarditis; oral switch; oral treatment; survival analysis.