The University of Kentucky Multidisciplinary Endocarditis Team recently published a seminal paper on the treatment of infective endocarditis with oral antibiotics. The team features the following internal medicine individuals, as well as members from the UK College of Medicine Departments of Surgery and Neurology, and the College of Pharmacy:
- Sami El-Dalati, MD – Division of Infectious Diseases
- Takaaki Kobayashi, MD, PhD, MPH – Division of Infectious Diseases
- Alexander Pomakov, MD – Division of Infectious Diseases
- Armaghan-E-Rehman Mansoor, MBBS – Division of Infectious Diseases
- David Olafsson, MD – Division of Infectious Diseases
- Nicholas J. Van Sickels, MD – Division of Infectious Diseases
- John Gurley, MD – Division of Cardiology
- Talal Alnabelsi, MD – Division of Cardiology
- Evan Hall, MD – Department of Internal Medicine
Endocarditis is a life-threatening bacterial or fungal infection of the inside of the heart, primarily of the heart valves. In approximately 10-15% of cases, patients will die in the hospital from the infection. Those who survive may suffer serious, debilitating complications such as stroke, heart failure, kidney failure, and loss of limb.
Kentucky as a state has a high incidence of endocarditis, particularly in Eastern Kentucky, as a consequence of higher rates of injection drug use. Injecting drugs, particularly if it is not done using clean equipment and sterile technique, can introduce bacteria directly into the bloodstream which then settle on the heart valves to cause endocarditis.
This study, the largest of its kind in the United States, reports on the outcomes of 93 patients with endocarditis treated with oral antibiotics compared to 136 patients treated with IV antibiotics and found no difference in 90-day mortality or re-infection outcomes. Over half of the patients in the oral arm had a history of substance use, and follow-up rates were robust at 80%.
Takaaki Kobayashi, MD, PhD, MPH, contributed to the study design, statistical analysis, and editing of the manuscript. “High-quality evidence supporting the use of oral antibiotics in the management of endocarditis remains limited, and standard practice has traditionally relied on prolonged intravenous therapy,” says Dr. Kobayashi. “However, extended IV treatment is associated with longer hospital stays, increased healthcare costs, and complications related to peripherally inserted central catheters. While further evidence is needed, this study supports the potential role of partial oral antibiotic therapy, which may offer meaningful benefits for both patients and the healthcare system.”
The Multidisciplinary Endocarditis Team hopes that their research will encourage more physicians to consider the use of antibiotics for patients with endocarditis caused by specific bacteria, including in patients with a history of substance use. They also hope that more hospitals will consider the use of a multidisciplinary team when treating patients with endocarditis.
Sami El-Dalati, MD, Director of the UK Multidisciplinary Endocarditis Program, remarks that “It's very encouraging to see all the different medical and surgical specialties collaborate so consistently for a specific disease. It's rare to have surgeons, infectious disease providers, and palliative care in the same room to discuss a patient and to be able to do this every week for over 4 years is truly remarkable, especially considering that everyone volunteers their time to be a part of this endeavor. I think this also highlights the role that other allied health care providers play in these teams, including nurse navigators, social workers, advanced practice providers, and pharmacists. It really took a complete team to produce this research and that's something we're all very proud of.”