Partial Oral Treatment of Endocarditis - POET

Mar 17, 2019
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Danish Heart Foundation, Capital Regions Research Council, Hartmanns’s Foundation, Svend Aage Andersens Foundation, Novo Nordisk Foundation
Date Presented:
03/17/2019
Date Published:
01/31/2019
Date Updated:
03/17/2019
Original Posted Date:
08/28/2018
References

Contribution To Literature:

The POET trial showed that oral antibiotics were noninferior to intravenous antibiotics at preventing adverse events.

Description:

The goal of the trial was to evaluate intravenous antibiotics compared with oral antibiotics among stable patients with infective endocarditis on the left side of the heart.


Study Design

  • Randomized
  • Parallel

Patients with infective endocarditis on the left side of the heart and stabilized with intravenous antibiotics were randomized to oral antibiotic therapy (n = 201) versus continuation of intravenous antibiotic therapy (n = 199).

Inclusion criteria:

  • Patients ≥18 years of age with infective endocarditis on the left side of the heart
  • Stable on intravenous antibiotic therapy for ≥10 days
  • Positive blood culture for streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase negative staphylococci
  • Total number of enrollees: 400
  • Duration of follow-up: 6 months
  • Mean patient age: 67 years
  • Percentage female: 25%
  • Percentage with diabetes: 18%

Other salient features/characteristics:

  • After randomization, continued antibiotic duration: 17 days in the oral group vs. 19 days in the intravenous group (p = 0.48)
  • Length of hospital stay after randomization: 3 days in the oral group vs. 19 days in the intravenous group (p < 0.001)

Principal Findings:

The primary outcome, all-cause death, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen at 6 months, occurred in 9.0% of the oral group compared with 12.1% of the intravenous group (p = 0.40; satisfying noninferiority).

All-cause death, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen at median of 3.5 years, occurred in 26.4% of the oral group compared with 38.2% of the intravenous group (p = 0.01).

Secondary outcomes:

  • All-cause mortality: 3.5% in the oral group vs. 6.5% in the intravenous group (p = not significant) 
  • All-cause mortality at median of 3.5 years: 16.4% in the oral group vs. 27.1% in the intravenous group (p = 0.009) 
  • Relapse of the positive blood culture: 2.5% in the oral group vs. 2.5% in the intravenous group (p = not significant)

Interpretation:

Among patients with infective endocarditis of the left side of the heart being treated with intravenous antibiotics, changing to oral antibiotic therapy was noninferior to remaining on intravenous antibiotics. The safety of this strategy was demonstrated in long-term follow-up. Individual components of the composite outcome were similar between treatment groups. Results do not apply to endocarditis on the right side of the heart or infection with one of the nonlisted species.

References:

Presented by Dr. Henning Bundgaard at the American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, March 17, 2019.

Iversen K, Ihlemann N, Gill SU, et al. Partial Oral Versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med 2019;380:415-24.

Editorial: Boucher HW. Partial Oral Therapy for Osteomyelitis and Endocarditis — Is It Time? N Engl J Med 2019;380:487-9.

Presented by Dr. Henning Bundgaard at the European Society of Cardiology Congress, Munich, Germany, August 28, 2018.

Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: ACC19, ACC Annual Scientific Session, ESC Congress, ESC18, Administration, Oral, Anti-Bacterial Agents, Bacteremia, Cardiac Surgical Procedures, Endocarditis, Endocarditis, Bacterial, Enterococcus, Enterococcus faecalis, Heart Valve Diseases, Primary Prevention, Staphylococcal Infections, Staphylococcus aureus, Streptococcus, Treatment Outcome


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