Can Antibiotics Wait for Blood Cultures in Endocarditis?

METHODOLOGY:

  • Researchers in Switzerland conducted a retrospective study at two university hospitals to assess the impact of delayed antimicrobial treatment on survival among patients with suspected and confirmed IE.
  • They reviewed 1230 bacteraemia episodes with suspected IE; immediate antimicrobial treatment was initiated in 675 episodes, and the treatment was delayed until preliminary blood culture results were available in 555 episodes.
  • The outcome assessed was 30-day mortality, and the 30-day composite primary endpoint included mortality, new embolic events, or new bone and joint infections in patients with suspected or confirmed IE.

TAKEAWAY:

  • Overall, 30-day mortality was not significantly different between immediate and delayed treatment groups (5% vs 5%; log-rank P = .854).
  • Among 597 episodes with confirmed IE, neither 30-day mortality (log-rank P = .174) nor the 30-day composite primary endpoint (log-rank P = .263) differed significantly between the immediate and delayed treatment groups.
  • Independent predictors of 30-day mortality were a Charlson Comorbidity Index of > 4 and persistent bacteraemia; the immediate initiation of antimicrobial therapy was not associated with reduced mortality.

The study findings advocate for a careful, patient-centered approach to initiating AT [antimicrobial treatment] in clinically stable patients with suspected IE, particularly in cases with diagnostic uncertainty helping to avoid unnecessary use of broad-spectrum antimicrobials

Scientific news

  • Can Antibiotics Wait for Blood Cultures in Endocarditis? In clinically stable patients with suspected or confirmed infective endocarditis (IE), deferring antimicrobial treatment until blood culture results were available was not associated with 30-day mortality or worse clinical outcomes compared with immediate antimicrobial treatment.
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