提示: 手机请竖屏浏览!

部分口服与静脉给予抗生素治疗心内膜炎的比较
Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis


Kasper Iversen ... 心脑血管疾病 • 2019.01.31
相关阅读
• 感染性心内膜炎 • 2017心脏瓣膜病治疗方案要点更新

摘要


背景

左心感染性心内膜炎患者通常接受抗生素静脉给药治疗长达6周。目前尚不清楚患者病情稳定后从抗生素静脉给药转为口服抗生素的疗效和安全性是否与继续静脉给药相似。

 

方法

在一项随机、非劣效性、多中心试验中,我们将链球菌、粪肠球菌、金黄色葡萄球菌或凝固酶阴性葡萄球菌引起左心心内膜炎,正在接受抗生素静脉给药治疗的400例病情稳定的成人患者随机分组,一组继续接受静脉给药治疗(199例患者),另一组转为口服抗生素治疗(201例患者)。所有患者接受抗生素静脉给药治疗至少10日。如果可行,口服治疗组患者出院接受门诊治疗。主要结局为从随机化至抗生素治疗完成后6个月期间,由全因死亡、非计划心脏手术、栓塞事件或主要病原体菌血症复发组成的复合结局。

 

结果

随机分组后,静脉给药治疗组和口服治疗组分别在19日(四分位距,14~25)和17日(四分位距,14~25)的中位时间后完成了抗生素治疗(P=0.48)。静脉给药治疗组和口服治疗组分别有24例患者(12.1%)和18例患者(9.0%)发生主要复合结局(组间差异,3.1个百分点;95%置信区间,-3.4~9.6;P=0.40),符合非劣效性标准。

 

结论

在病情稳定的左心心内膜炎患者中,抗生素静脉给药治疗转为口服抗生素治疗不劣于继续抗生素静脉给药治疗(由丹麦心脏基金会[Danish Heart Foundation]等资助;POET在ClinicalTrials.gov注册号为NCT01375257)。





作者信息

Kasper Iversen, M.D., D.M.Sc., Nikolaj Ihlemann, M.D., Ph.D., Sabine U. Gill, M.D., Ph.D., Trine Madsen, M.D., Ph.D., Hanne Elming, M.D., Ph.D., Kaare T. Jensen, M.D., Ph.D., Niels E. Bruun, M.D., D.M.Sc., Dan E. Høfsten, M.D., Ph.D., Kurt Fursted, M.D., D.M.Sc., Jens J. Christensen, M.D., D.M.Sc., Martin Schultz, M.D., Christine F. Klein, M.D., Emil L. Fosbøll, M.D., Ph.D., Flemming Rosenvinge, M.D., Henrik C. Schønheyder, M.D., D.M.Sc., Lars Køber, M.D., D.M.Sc., Christian Torp-Pedersen, M.D., D.M.Sc., Jannik Helweg-Larsen, M.D., D.M.Sc., Niels Tønder, M.D., D.M.Sc., Claus Moser, M.D., Ph.D., and Henning Bundgaard, M.D., D.M.Sc.
From the Department of Cardiology, Herlev-Gentofte University Hospital (K.I., M.S., C.F.K.), Department of Cardiology, the Heart Center, Rigshospitalet, Copenhagen University Hospital (N.I., D.E.H., E.L.F., L.K., H.B.), the Departments of Infectious Diseases (J.H.-L.) and Clinical Microbiology (C.M.), Rigshospitalet, the Department of Cardiology, Hillerød Hospital (N.T.), and the Department of Clinical Microbiology, Slagelse Hospital and Institute of Clinical Medicine (J.J.C.), University of Copenhagen, Copenhagen, the Departments of Cardiology (S.U.G.) and Clinical Microbiology (F.R.), Odense University Hospital, Odense, the Departments of Cardiology (T.M.) and Cardiology and Epidemiology and Biostatistics (C.T.-P.), Aalborg University Hospital, the Department of Clinical Microbiology, Aalborg University Hospital, Aalborg University (H.C.S.), and the Department of Health Science and Technology, Aalborg University (C.T.-P.), Aalborg, the Department of Cardiology, Zealand University Hospital, Roskilde (H.E.), the Department of Cardiology, Aarhus University Hospital, Aarhus (K.T.J.), the Department of Cardiology, University Hospital of Copenhagen, Gentofte (N.E.B.), and the Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen (K.F.) — all in Denmark. Address reprint requests to Dr. Bundgaard at the Department of Cardiology B 2141, the Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark, or at henning.bundgaard@regionh.dk.

 

参考文献

1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015;132:1435-1486.

2. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075-3128.

3. Delahaye F, Alla F, Béguinot I, et al. In-hospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period. Scand J Infect Dis 2007;39:849-857.

4. Mistiaen WP. What are the main predictors of in-hospital mortality in patients with infective endocarditis: a review. Scand Cardiovasc J 2018;52:58-68.

5. Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J 2010;31:1890-1897.

6. Dickerman SA, Abrutyn E, Barsic B, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). Am Heart J 2007;154:1086-1094.

7. Martín-Dávila P, Navas E, Fortún J, et al. Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size. Am Heart J 2005;150:1099-1106.

8. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009;169:463-473.

9. Kehlet H. Fast-track colorectal surgery. Lancet 2008;371:791-793.

10. Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007;245:867-872.

11. Wind J, Polle SW, Fung Kon Jin PH, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93:800-809.

12. Andrews MM, von Reyn CF. Patient selection criteria and management guidelines for outpatient parenteral antibiotic therapy for native valve infective endocarditis. Clin Infect Dis 2001;33:203-209.

13. Lacroix A, Revest M, Patrat-Delon S, et al. Outpatient parenteral antimicrobial therapy for infective endocarditis: a cost-effective strategy. Med Mal Infect 2014;44:327-330.

14. Al-Omari A, Cameron DW, Lee C, Corrales-Medina VF. Oral antibiotic therapy for the treatment of infective endocarditis: a systematic review. BMC Infect Dis 2014;14:140-140.

15. Heldman AW, Hartert TV, Ray SC, et al. Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users: prospective randomized comparison with parenteral therapy. Am J Med 1996;101:68-76.

16. Dworkin RJ, Lee BL, Sande MA, Chambers HF. Treatment of right-sided Staphylococcus aureus endocarditis in intravenous drug users with ciprofloxacin and rifampicin. Lancet 1989;2:1071-1073.

17. Iversen K, Høst N, Bruun NE, et al. Partial oral treatment of endocarditis. Am Heart J 2013;165:116-122.

18. Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients. Clin Microbiol Infect 2016;22:607-612.

19. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633-638.

20. Infectious endocarditis. Danish guidelines. 2017. (In Danish) (http://www.nbv.cardio.dk/endocarditis).

21. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) home page. 2017 (http://eucast.org).

22. Gerds TA. Prodlim: product-limit estimation for censored event history analysis. 2017 (https://rdrr.io/cran/prodlim/).

23. R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2017.

24. Viechtbauer W. Conducting meta-analysis in R with the metafor package. J Stat Softw 2010;36(3):1-48.

25. Thomas DJ. The present status of penicillin therapy in the treatment of subacute bacterial endocarditis. Med J Aust 1949;1:377-379.

26. Bloomfield AL. The present status of treatment of subacute bacterial endocarditis. Circulation 1950;2:801-810.

27. Berg SK, Preisler P, Pedersen BD. Patients perspective on endocarditis — an intermezzo in life. Eur J Cardiovasc Nurs 2010;9:126-131.

28. Verhagen DW, Hermanides J, Korevaar JC, et al. Health-related quality of life and posttraumatic stress disorder among survivors of left-sided native valve endocarditis. Clin Infect Dis 2009;48:1559-1565.

29. de Saint-Hubert M, Schoevaerdts D, Poulain G, Cornette P, Swine C. Risk factors predicting later functional decline in older hospitalized patients. Acta Clin Belg 2009;64:187-194.

30. Isaia G, Maero B, Gatti A, et al. Risk factors of functional decline during hospitalization in the oldest old. Aging Clin Exp Res 2009;21:453-457.

服务条款 | 隐私政策 | 联系我们