Efficacy and safety of outpatient parenteral antibiotic therapy in patients with infective endocarditis: a meta-analysis

Abstract

Background. To investigate the clinical outcome of patients with infective endocarditis (IE) during and after outpatient parenteral antimicrobial treatment (OPAT), and to further clarify the safety and efficacy of OPAT for IE patients. Methods. Through December 20, 2021, a total of 331 articles were preliminarily searched in Pubmed, Web of Science, Cochrane Library and Embase, and 9 articles were eventually included in this study. Results. A total of 9 articles comprising 1,116 patients were included in this study. The overall mortality rate of patients treated with OPAT was 0.04 (95% CI, 0.02-0.07), that means 4 deaths per 100 patients treated with OPAT. Separately, mortality was low during the follow-up period after OPAT treatment, with an effect size (ES) of 0.03 (95%CI, 0.02-0.07) and the mortality of patients during OPAT treatment was 0.04 (95% CI, 0.01-0.12). In addition, the readmission rate was found to be 0.14 (95% CI, 0.09-0.22) during the follow-up and 0.18 (95% CI, 0.08-0.39) during treatment, and 0.16 (95% CI, 0.10-0.24) for patients treated with OPAT in general. Regarding the relapse of IE in patients, our results showed a low overall relapse rate, with an ES of 0.03 (95% CI, 0.01-0.05). In addition, we found that the incidence of adverse events was low, with an ES of 0.26 (95% CI, 0.19-0.33). Conclusion. In general, the incidence of adverse events and mortality, readmission, and relapse rates in IE patients treated with OPAT are low both during treatment and follow-up period after discharge, indicating that OPAT is safe and effective for IE patients. However, our study did not compare routine hospitalization as a control group, so conclusions should be drawn with caution. In order to obtain more scientific and rigorous conclusions and reduce clinical risks, it is still necessary to conduct more research in this field and improve the patient selection criteria for OPAT treatment, especially for IE patients. Finally, clinical monitoring and follow-up of OPAT-treated patients should be strengthened.

Terapia antimicrobiana parenteral para pacientes internados e ambulatoriais: uma análise de custo na transição do cuidado

“…In the study by Suleyman et al, it was shown that home therapy is safe and associated with clinical results, including improvements in quality of life, comparable to those of hospitalizations 13 . The studies found that home therapy was not associated with a clinically important increase in adverse reactions and that it was significantly less expensive than in-hospital therapy, an observation consistent with other cost analyses 7,10 . This resoluteness profile is also relevant for epidemiological indicators to be favorable, decreasing mortality due to these causes, reducing hospital readmissions and optimizing costs for the public and private health networks 10,13,14,15 .…”

Endocardite Infecciosa: Uma Revisão De Literatura

“…Em uma metanálise com 1.116 pacientes, Wen et al, (2022) concluíram que, em geral, a incidência de eventos adversos e as taxas de mortalidade, readmissão e recaída em pacientes com EI tratados com terapia parenteral ambulatorial são baixas durante o tratamento e no período de acompanhamento após a alta, indicando que a terapia é segura e eficaz para pacientes com EI. No entanto, visando conclusões mais científicas e rigorosas e reduzir os riscos clínicos, o estudo afirma que são necessários mais estudos nesta área.…”

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

“…Presently, the oral switch is not widely implemented because stronger evidence is still required. Instead, solid evidence over the years is set on the effective and safe use of OPAT for endocarditis treatment [ 84 ].…”