Suppressive antibiotic therapy for infectious endocarditis

Abstract Purpose: Suppressive antibiotic therapy (SAT) is a long-term antibiotic strategy sometimes used when an indicated surgical management of infective endocarditis (IE) is not possible. Our aim was to describe characteristics and outcomes of patients who received SAT for IE. Methods: We conducted a monocentric, observational study at Strasbourg University Hospital, France between January 1st 2020 and May 30th 2023. We reviewed all medical files discussed at weekly meetings of the local Multidisciplinary Endocarditis Team (MET) during the study period. The primary endpoint was all-cause mortality at last follow-up. Secondary endpoints included all-cause mortality at 3 months and 6 months follow-up, infection relapse and occurrence of tolerance issues attributed to SAT. Results: The local MET discussed 251 patients with during the study time, among whom we included 22 patients (9%) who received SAT. The mean age was 77.2 ± 12.3 years. Patients were highly comorbid with a mean Charlson index score of 6.6 ± 2.5. Fourteen patients (64%) had prosthetic valve endocarditis. Six patients (27%) had IE affecting cardiac implantable electronic devices. Median follow-up time was 249 days (IQR 95 – 457 days). At last follow-up date, all-cause mortality was of 23% (5/22). Three patients (14%) presented tolerance issues attributed to SAT, and 2 patients (9%) presented late infectious relapse. Conclusion: Mortality at 3-month follow-up was low and tolerance issues were rare for patients under SAT for IE in this study. It might be a palliative approach to consider when conventional management involving surgery or device removal is not deemed possible.