Risk factors for failure of outpatient parenteral antibiotic therapy (OPAT) in infective endocarditis

Duncan, C. J. A., Barr, D. A., Ho, A. , Sharp, E., Semple, L. and Seaton, R. A. (2013) Risk factors for failure of outpatient parenteral antibiotic therapy (OPAT) in infective endocarditis. Journal of Antimicrobial Chemotherapy, 68(7), pp. 1650-1654. (doi:10.1093/jac/dkt046) (PMID:23475647) (PMCID:PMC3682687)

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Abstract

Objectives: To identify risk factors for failure of outpatient antibiotic therapy (OPAT) in infective endocarditis (IE). Patients and methods: We identified IE cases managed at a single centre over 12 years from a prospectively maintained database. ‘OPAT failure’ was defined as unplanned readmission or antibiotic switch due to adverse drug reaction or antibiotic resistance. We analysed patient and disease-related risk factors for OPAT failure by univariate and multivariate logistic regression. We also retrospectively collected follow-up data on adverse disease outcome (defined as IE-related death or relapse) and performed Kaplan–Meier survival analysis up to 36 months following OPAT. Results: We identified 80 episodes of OPAT in IE. Failure occurred in 25/80 episodes (31.3%). On multivariate analysis, cardiac or renal failure [pooled OR 7.39 (95% CI 1.84–29.66), P = 0.005] and teicoplanin therapy [OR 8.69 (95% CI 2.01–37.47), P = 0.004] were independently associated with increased OPAT failure. OPAT failure with teicoplanin occurred despite therapeutic plasma levels. OPAT failure predicted adverse disease outcome up to 36 months (P = 0.016 log-rank test). Conclusions: These data caution against selecting patients with endocarditis for OPAT in the presence of cardiac or renal failure and suggest teicoplanin therapy may be associated with suboptimal OPAT outcomes. Alternative regimens to teicoplanin in the OPAT setting should be further investigated.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Ho, Dr Antonia
Authors: Duncan, C. J. A., Barr, D. A., Ho, A., Sharp, E., Semple, L., and Seaton, R. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Journal of Antimicrobial Chemotherapy
Publisher:Oxford University Press
ISSN:0305-7453
ISSN (Online):1460-2091
Published Online:08 March 2013
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in Journal of Antimicrobial Chemotherapy 68(7):1650-1654
Publisher Policy:Reproduced under a Creative Commons License

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