Effective treatment of endocarditis: A Synthesis of Findings from 16 Studies

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Original Abstract of the Article

Major Research Findings

Infective endocarditis (IE) is a serious infection of the heart's inner lining, which can lead to significant complications and even death. 8 explores the different outcomes associated with using biological versus mechanical prosthetic valves in IE treatment. While surgery is a common treatment, it remains unclear which type of valve offers better prognosis. Furthermore, 16 explores the potential benefits of outpatient parenteral antimicrobial therapy (OPAT) in IE treatment, indicating it might be a safe and effective option for certain patients.

Antibiotics play a crucial role in treating IE. 1 and 2 investigate the efficacy of daptomycin, a newer antibiotic, in treating IE and bacteremia. Additionally, 13 suggests the potential effectiveness of shorter antibiotic regimens compared to traditional 4-6 week courses in patients with stable IE and positive response to treatment.

IE can cause significant physical and mental strain, often necessitating rehabilitation. 14 investigates the impact of cardiac rehabilitation on patients recovering from IE, indicating potential benefits in improving physical and mental well-being. 15 explores the psychological impact of partial oral treatment in IE, suggesting it might help reduce anxiety and depression in some patients.

Surgery may be necessary for certain IE cases. 4 indicates that early surgery for patients with severe valve disease and large vegetations might significantly reduce the risk of complications like stroke, potentially improving overall outcomes.

Treatment Summary

Treatment for IE typically involves a combination of antibiotic therapy and surgery. 7 emphasizes that antibiotics are a cornerstone of IE treatment, although the specific regimen can vary based on individual circumstances and the type of bacteria involved. Depending on the severity of the condition, surgical intervention may be required, including valve replacement or repair. The duration of treatment varies based on the individual case but often extends from weeks to months. Post-treatment, regular check-ups are essential to monitor for any potential complications and ensure long-term health.

Benefits and Risks

Benefit Summary

Treating IE can prevent further infection spread, save lives, and improve overall health. Early surgical intervention in specific cases might effectively reduce the risk of serious complications like stroke. Cardiac rehabilitation offers potential benefits in improving physical and mental well-being, while partial oral treatment might contribute to alleviating anxiety and depression in some patients.

Risk Summary

Potential risks associated with IE treatment include adverse effects from antibiotic use and complications from surgery. Antibiotic side effects can range from gastrointestinal issues and allergic reactions to potential renal complications. Surgical risks include bleeding, infection, and valve malfunction.

Comparison of Studies

Commonalities

Multiple studies consistently indicate the importance of antibiotic therapy in IE treatment. Furthermore, the need for surgical intervention in certain cases is also a recurring theme across these studies.

Differences

Research findings vary in terms of recommended antibiotic regimens, surgical timing, and the need for rehabilitation. These differences could be attributed to the varying patient populations studied, the specific type of IE, and the designs of the individual studies.

Consistency and Contradictions in Results

Some contradictions exist within the research findings regarding IE treatment. While certain studies highlight the effectiveness of daptomycin, others suggest it might not always be the optimal choice. These discrepancies could arise from variations in patient populations, infection types, and research methodologies.

Real-World Implications and Cautions

Treatment approaches for IE are highly individualized and depend on factors like patient condition, type of infection, and the severity of the condition. Consequently, directly applying research findings to individual treatment decisions is not advisable. It is crucial to consult with a physician for personalized guidance and treatment plans.

Limitations of Current Research

Further research is needed to fully understand the complexities of IE treatment. Long-term studies are necessary to evaluate the long-term outcomes and effectiveness of different treatment approaches. Additionally, many studies involve limited patient populations, which can impact the generalizability and reliability of findings.

Future Directions for Research

Future research should focus on the following key areas:

  • Developing standardized, optimal treatment approaches for various types of IE.
  • Conducting comprehensive, long-term studies to assess the long-term outcomes and effects of different treatment modalities.
  • Further exploring the benefits of cardiac rehabilitation in improving overall patient well-being after IE treatment.

Conclusion

While IE is a serious condition, with proper treatment, many patients can fully recover. The research summarized here provides valuable insights into the complexities of IE treatment. However, it is vital to consult with a physician for personalized guidance and treatment plans. Continued research is crucial to enhance our understanding of IE and develop even more effective and targeted treatment strategies.

Treatment List

  • Antibiotic therapy
  • Surgery (valve replacement/repair)
  • Cardiac rehabilitation
  • Outpatient Parenteral Antimicrobial Therapy (OPAT)
  • Partial oral treatment
Literature analysis of 16 papers
Positive Content
15
Neutral Content
1
Negative Content
0
Article Type
7
5
6
6
16
1.

Daptomycin for endocarditis and/or bacteraemia: a systematic review of the experimental and clinical evidence.

Author: FalagasMatthew E, GiannopoulouKonstantina P, NtzioraFotinie, VardakasKonstantinos Z

Treat bacteremia
Treat endocarditis

Daptomycin, a cyclic lipopeptide, shows promise as a treatment option for endocarditis and bacteremia caused by gram-positive cocci.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

2.

Daptomycin compared to standard therapy for the treatment of native valve endocarditis.

Author: KanafaniZeina, BoucherHelen, FowlerVance, CabellChristopher, HoenBruno, MiróJosé M, LalaniTahaniyat, ViglianiGloria, CampionMarilyn, CoreyRalph, LevineDonald

Daptomycin effective RIE
LIE poor outcome

Daptomycin was found to be an effective and well-tolerated treatment for right-sided endocarditis (RIE), with similar success rates compared to standard therapy. However, left-sided endocarditis (LIE) patients had poor outcomes regardless of treatment. Daptomycin was also effective in treating endocarditis with septic pulmonary infarcts.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

[Infective endocarditis. Systematic review of twenty years of performances in the Sociedad Argentina de Medicina].

Author: MarceloYorio, Milian AndrésEscudero, LuisCamera

Infective endocarditis (IE) in Argentina showed similar characteristics to other countries, with fever, murmur, and elevated sedimentation rate being the most common clinical features. Stafilococcus spp was the most frequent causative organism.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : Spanish

4.

Early surgery versus conventional treatment for infective endocarditis.

Author: KangDuk-Hyun, KimYong-Jin, KimSung-Han, SunByung Joo, KimDae-Hee, YunSung-Cheol, SongJong-Min, ChooSuk Jung, ChungCheol-Hyun, SongJae-Kwan, LeeJae-Won, SohnDae-Won

Reduced embolism

Early surgery significantly reduced the composite end point of death from any cause and embolic events in patients with infective endocarditis and large vegetations compared with conventional treatment.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Partial oral treatment of endocarditis.

Author: IversenKasper, HøstNis, BruunNiels Eske, ElmingHanne, PumpBettina, ChristensenJens Jørgen, GillSabine, RosenvingeFlemming, WiggersHenrik, FuurstedKurt, Holst-HansenClaus, KorupEva, SchønheyderHenrik Carl, HassagerChristian, HøfstenDan, LarsenJannik Helweg, MoserClaus, IhlemannNikolaj, BundgaardHenning

Reduced side effects
Shortened hospital stay

Current guidelines recommend giving antibiotics through a vein (intravenously) for 4-6 weeks to treat left-sided infective endocarditis (IE). Switching to oral antibiotics in patients who are stable could reduce side effects and hospital stays. While there's limited evidence, some observations suggest that this approach might be safe and effective.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

6.

Oral antibiotic therapy for the treatment of infective endocarditis: a systematic review.

Author: Al-OmariAwad, CameronD William, LeeCraig, Corrales-MedinaVicente F

Improved cure rates

The use of oral ciprofloxacin in combination with rifampin for uncomplicated right-sided S. aureus IE in intravenous drug users (IVDUs) is supported by one small clinical trial of relatively good quality and could be considered when conventional IV antibiotic therapy is not possible.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

A comparison of different antibiotic regimens for the treatment of infective endocarditis.

Author: Martí-CarvajalArturo J, DayerMark, ConternoLucieni O, Gonzalez GarayAlejandro G, Martí-AmaristaCristina Elena, Simancas-RacinesDaniel

This Cochrane review assessed the existing evidence regarding the efficacy and safety of various antibiotic regimens for treating infective endocarditis. Limited and very low quality evidence suggested no conclusive differences between antibiotic regimens in terms of cure rates or other clinical outcomes. Due to the low quality of evidence, further research is needed.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

The prognosis of infective endocarditis treated with biological valves versus mechanical valves: A meta-analysis.

Author: TaoEnde, WanLi, WangWenJun, LuoYunLong, ZengJinFu, WuXia

Improved prognosis
Infective endocarditis

This meta-analysis compared the prognosis of infective endocarditis (IE) treated with biological valves versus mechanical valves.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis.

Author: IversenKasper, IhlemannNikolaj, GillSabine U, MadsenTrine, ElmingHanne, JensenKaare T, BruunNiels E, HøfstenDan E, FurstedKurt, ChristensenJens J, SchultzMartin, KleinChristine F, FosbøllEmil L, RosenvingeFlemming, SchønheyderHenrik C, KøberLars, Torp-PedersenChristian, Helweg-LarsenJannik, TønderNiels, MoserClaus, BundgaardHenning

Infective endocarditis treatment
Oral antibiotics

People with a heart infection (infective endocarditis) on the left side of the heart are usually treated with intravenous antibiotics for up to six weeks. It's unclear if switching to oral antibiotics once the patient is stable would be as effective and safe as continuing intravenous treatment.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Equivalence TrialA clinical trial designed to show that a new treatment is equivalent in efficacy/safety to an existing treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Acute Ischemic Stroke Treatment in Infective Endocarditis: Systematic Review.

Author: BettencourtSofia, FerroJosé M

Safer stroke treatment
Intracranial bleeding

Thrombectomy in infective endocarditis associated stroke appears to be safer than thrombolysis, or combined treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Partial oral antibiotic therapy is non-inferior to intravenous therapy in non-critically ill patients with infective endocarditis : Review and meta-analysis.

Author: RezarRichard, JirakPeter, LichtenauerMichael, JungChristian, LautenAlexander, HoppeUta C, WernlyBernhard

Reduced costs
Shorter hospital stays

Intravenous (i.v.) antibiotic therapy for infective endocarditis (IE) typically lasts for 6 weeks or more. This review meta-analyzes studies comparing i.v. therapy to partial oral therapy (POT) for non-critically ill patients with IE.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

A comparison of different antibiotic regimens for the treatment of infective endocarditis.

Author: Martí-CarvajalArturo J, DayerMark, ConternoLucieni O, Gonzalez GarayAlejandro G, Martí-AmaristaCristina Elena

Infective endocarditis treatment

Infective endocarditis is a serious infection of the heart's inner lining caused by bacteria. Antibiotics are the main treatment, but there's no one-size-fits-all approach because the symptoms, people affected, and types of bacteria involved vary. This review updates previous research on this topic.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Short-course antibiotic regimen compared to conventional antibiotic treatment for gram-positive cocci infective endocarditis: randomized clinical trial (SATIE).

Author: OlmosCarmen, VilacostaIsidre, LópezJavier, SáezCarmen, AnguitaManuel, García-GranjaPablo Elpidio, SarriáCristina, SilvaJacobo, Álvarez-ÁlvarezBelén, Martínez-MonzonisMaría Amparo, CastilloJuan Carlos, SeijasJosé, López-PicadoAmanda, PeralVicente, MarotoLuis, San RománJ Alberto

IE treatment

Infective endocarditis (IE) is a serious heart infection. Most complications happen early on, but many patients who survive the initial phase recover well. However, they often stay in the hospital for a long time to finish antibiotic treatment. This study will test whether a shorter course of antibiotics is just as safe and effective as the standard 4 to 6 weeks of treatment for patients who are stable and responding well to treatment.

Clinical Trial, Phase IVPost-marketing surveillance. Monitors long-term safety/efficacy after approval.
Equivalence TrialA clinical trial designed to show that a new treatment is equivalent in efficacy/safety to an existing treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

14.

Comprehensive cardiac rehabilitation for patients following infective endocarditis: results of the randomized CopenHeartIE trial.

Author: RasmussenTrine Bernholdt, ZwislerAnn-Dorthe, RisomSigne Stelling, SibilitzKirstine Lærum, ChristensenJan, BundgaardHenning, MoonsPhilip, ThygesenLau Caspar, LindschouJane, NorekvålTone Merete, BergSelina Kikkenborg

Cardiac rehabilitation after endocarditis

This trial investigated the effects of cardiac rehabilitation in patients following infective endocarditis, considering the common occurrence of physical and mental deconditioning in this population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

15.

The impact of partial-oral endocarditis treatment on anxiety and depression in the POET trial.

Author: BundgaardJohan S, IversenKasper, Pries-HejeMia, IhlemannNikolaj, BakTheis S, ØstergaardLauge, GillSabine U, MadsenTrine, ElmingHanne, JensenKaare T, BruunNiels E, HøfstenDan E, FuurstedKurt, ChristensenJens J, SchultzMartin, RosenvingeFlemming, SchønheyderHenrik C, Helweg-LarsenJannik, KøberLars, Torp-PedersenChristian, FosbølEmil L, TønderNiels, MoserClaus, BundgaardHenning, MogensenUlrik M

Reduced anxiety and depression

This study investigated the psychological impact of different treatment strategies for left-sided infective endocarditis. The Partial-Oral versus Intravenous Antibiotic Treatment of Endocarditis Trial (POET) demonstrated the non-inferiority of partial-oral outpatient treatment compared to conventional in-hospital intravenous treatment. This study found that the treatment strategy did not significantly affect levels of anxiety and depression.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

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

Author: WenW, LiH, WangC, ChenC, TangJ, ZhouM, HongX, ChengY, WuQ, ZhangX, FengZ, WangM

Low mortality
Low readmission
Safe treatment
Relapse possible

Outpatient parenteral antimicrobial treatment (OPAT) was safe and effective for patients with infective endocarditis (IE). The mortality rate was 4%, readmission rate was 16%, and relapse rate was 3%. However, the study did not include a comparison with routine hospitalization, so conclusions should be drawn with caution.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

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