Abstract
BACKGROUND: Despite trial data supporting oral stepdown therapy for infective endocarditis (IE), its use remains limited, especially in North America. We evaluated outcomes of patients with IE managed by a multidisciplinary team and treated with either intravenous (IV) or partial oral antibiotics. METHODS: This was a single-center retrospective study of patients with definite IE identified from an institutional registry between 7 September 2021 and 1 March 2025. Clinical and outcomes data were analyzed using multivariable logistic regression. RESULTS: Of 236 patients, 143 received IV therapy alone and 93 were transitioned to partial oral therapy. Baseline characteristics were similar, though valve surgery was more frequent in the oral group (40.9% vs 28.0%; P = .04). There were no significant differences in 90-day relapsed infection (0.7% vs 2.2%; P = .32), 90-day all-cause mortality (2.8% vs 6.5%; P = .17), or the composite of both outcomes (3.5% vs 8.6%; P = .09). There was no difference in relapsed infection or all-cause mortality at 90 days for patients with methicillin-resistant Staphylococcus aureus transitioned to oral therapy. In multivariable analysis, oral therapy was not associated with increased 90-day mortality (odds ratio [OR], 1.72 [95% confidence interval {CI} .41-7.24]; P = .46). Independent predictors of mortality included older age (OR, 1.06 per year [95% CI, 1.00-1.13]; P < .001), acute heart failure (OR, 18.61), and discharge before medically advised (OR, 8.60). CONCLUSIONS: In selected patients managed by a multidisciplinary team, partial oral therapy for IE appears to be safe and effective, with outcomes comparable to exclusive IV treatment, consistent with European guidelines.