Short- and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge: A Retrospective Cohort Study

Short- and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Short- and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge: A Retrospective Cohort Study Kyle Crooker, YuTing He, Tim Lahey, Tess Hickey, Max HoddWells, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4797948/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background There is an increase of patients with infective endocarditis who undergo patient-directed discharge prior to completion of the recommended duration of parenteral antibiotics. Outcomes of patients with infective endocarditis who do or do not undergo patient-directed discharge have not been clearly elucidated. Methods A retrospective cohort study was done on all adult patients with infective endocarditis admitted at a single center between 2010–2020 who did or did not undergo patient-directed discharge. The authors compared baseline characteristics as well as 30-day, 90-day, 1-year, and 2-year outcomes. Results A total of 389 patients were included, with 47 in the patient-directed discharge cohort and 342 in the non-patient-directed discharge cohort. The patient-directed discharge cohort was younger and more likely to use intravenous drugs, but less likely to suffer from chronic diseases. The patient-directed discharge cohort was more likely to be infected with S. aureus , to experience right-sided valvular disease, and to receive less parenteral antibiotics. While there was no significant difference in mortality, the patient-directed discharge cohort had increased risk of complications. Conclusions Patients with infective endocarditis who undergo patient-directed discharge have significantly different baseline characteristics and are more likely to have complications of infective endocarditis when compared to non-patient-directed discharge, but with no significant difference in mortality. infective endocarditis patient-directed discharge against medical advice Background Infective endocarditis (IE) is a lethal infection that requires intensive multidisciplinary hospital care at diagnosis. [ 1 ] Mortality for patients experiencing IE approaches 30% at 30 days. [ 2 , 3 ] The healthcare burden of IE has recently been increasing; hospitalizations have increased from 0.32 to 0.75 cases per 100,000 hospitalizations in the United States over the last twenty years. [ 2 , 4 , 5 ] The current standard of care for IE is 4–6 weeks of culture-directed intravenous antibiotics, [ 6 ] and surgical intervention is required in 20–50% of cases. [ 7 ] This standard of care typically involves an initial hospital-based phase of care followed by outpatient parenteral antibiotics, although this approach is evolving in response to the partial oral treatment of endocarditis (POET) and other clinical studies suggesting that some patients can be cured after an early transition to oral antibiotics. [ 8 – 10 ] Patients who leave the hospital prematurely are an important, challenging, and growing subset of the IE population. Patient-directed (formerly called against medical advice or AMA) discharges (PDD) are higher in people who inject drugs (PWID), as is IE, and PDDs are rising in this population. Prior data suggest 14–29% of admissions among PWID with IE result in PDD, compared to 1.9% in patients with IE and no intravenous drug use, and that PDD in PWID with IE increased 12% per year from 2010 to 2015. [ 11 – 14 ] Furthermore, in a national database from 2016–2019, 89% of 4,310 patients with IE who had a PDD were identified as PWID. [ 14 ] Prior data has also suggested that patients with IE who have a PDD have worse outcomes. Thirty-day readmission rates in this group approach 50%, as opposed to 21% among patients with IE without a PDD. [ 12 , 15 ] Rates of recurrent bacteremia, new emboli, and overall mortality have also been shown to be significantly higher among IE patients with PDD. [ 13 ] Given the growth of the PDD population and increasing prevalence of IE, and new data suggesting that some patients can be cured after an early transition to oral therapy, we assessed the short- and long-term clinical outcomes in patients with IE who do and do not undergo a PDD. Methods Study Design, Setting, Population, and Ethical Approval We conducted a retrospective cohort study in adult patients admitted to the University of Vermont (UVM) Medical Center, Burlington, Vermont, from 2010–2020, comparing outcomes between those who did or did not undergo a PDD. UVM Medical Center is a tertiary care academic hospital with 620 licensed beds and serves an urban and rural population in Vermont and New York of approximately one million persons. We included all patients over 18 years of age with infective endocarditis, as identified by ICD (International Classification of Diseases) 10 codes and excluded patients from the analyses if they did not meet the definition of endocarditis as defined by the modified Duke criteria and IDSA (Infectious Diseases Society of America) guidelines. [ 6 ] Patients with endocarditis from a fungi or fastidious organism, such as from Bartonella or Coxiella, were excluded from certain parts of the analysis such as length of antibiotic treatment and length of positive blood cultures, given significant expected differences relative to normal bacterial IE. At least two members of the study team performed manual chart review of each patient’s demographic characteristics, clinical findings and ultimate outcome. All reviewers received training, and differences were adjudicated by a third physician review. The study was approved by the UVM Institutional Review Board. Outcomes We compared baseline demographic data, comorbidities, and clinical details between patients who did or did not undergo PDD. Our primary outcomes were 30-day, 90-day, 1-year, and 2-year mortality, IE-related mortality, and IE-related readmission rates. Secondary outcomes included microbiologic failure (recurrence of bacteremia from the original organism), treatment failure, (death, new paravalvular abscess, new heart failure from IE, new valve replacement, new IE-related orthopedic procedure, or a new metastatic site of infection), and a change in the organism causing bacteremia. We also compared the primary and secondary outcomes among patients depending on the length of intravenous and oral antibiotics they received to assess what combinations approximated the outcomes of the current standard of care, which is typically 42 days of intravenous antibiotics. [ 6 ] Statistical analyses We collected study data into a REDCap electronic database [ 16 , 17 ] and conducted statistical analyses in Stata [Stata 16.1, Stata Corp, LLC. College Station, TX]. We compared demographics, clinical findings and outcomes between patients who experienced PDD and those who did not via Wilcoxon rank sum test for continuous variables and via chi-square analysis or Fisher’s exact test for categorical variables. Odds ratios were calculated via logistic regression. Results We included 389 patients in our analyses based on inclusion and exclusion criteria. Demographic characteristics between groups are shown in Table 1 . Notably, the PDD cohort differed from the non-PDD cohort in several important ways: they were younger (average age 33 years versus 61 years; p < 0.01), more likely to have Medicaid for insurance (75% versus 28%; p < 0.01), and more likely to experience homelessness (17% versus 6%; p = 0.01). The PDD cohort was more likely to smoke tobacco (89% versus 33%; p < 0.01) and use intravenous drugs (87% versus 27%; p < 0.01). The PDD cohort was more likely to suffer from hepatitis C virus (72% versus 27%; p < 0.01) and have a history of psychiatric disease (53% versus 33%; p < 0.01), but otherwise the PDD cohort was less likely to suffer from chronic diseases including chronic kidney disease (6% versus 22%; p = 0.01), coronary artery disease (2% versus 25%; p < 0.01), pre-existing prosthetic heart valve (0% versus 22%; p < 0.01), chronic heart failure (0% versus 16%; p < 0.01), and diabetes (4% versus 25%; p < 0.01). Table 1 Comparison of baseline demographics between patients who did or did not undergo patient-directed discharge Non-PDD (n = 342)(%) PDD (n = 47)(%) p-value Age (years)(interquartile range) 61 (39–73) 33 (28–38) < 0.01 Gender: female 130 (38.0) 24 (51.1) 0.09 Race: Caucasian 323 (96.1) 46 (97.9) 1.00 Ethnicity: non-Hispanic 330 (98.8) 45 (100.0) 1.00 Insurance: Medicaid 97 (28.4) 35 (74.7) < 0.01 Homelessness 22 (6.4) 8 (17.0) 0.01 Tobacco use disorder 109 (33.0) 42 (89.4) < 0.01 Alcohol use disorder 55 (16.2) 6 (13.0) 0.58 Intravenous drug use 92 (26.9) 41 (87.2) < 0.01 Other substance use 93 (27.4) 35 (74.5) < 0.01 Marijuana 39 (11.5) 14 (29.8) < 0.01 Methamphetamines 11 (3.2) 9 (19.2) < 0.01 Cocaine 46 (13.6) 25 (53.2) < 0.01 Opioids 44 (13.0) 17 (36.2) < 0.01 Other 8 (2.4) 2 (4.3) 0.35 Chronic kidney disease 75 (22.0) 3 (6.4) 0.01 Cirrhosis 22 (6.4) 3 (6.4) 1.00 HIV infection 3 (1.1) 0 (0.0) 1.00 HCV, positive serology 75 (26.8) 33 (71.7) < 0.01 Psychiatric disease 114 (33.3) 25 (53.2) 0.01 Pre-existing prosthetic heart valve 76 (22.2) 0 (0.0) < 0.01 Coronary artery disease 85 (24.9) 1 (2.1) < 0.01 Chronic heart failure 56 (16.4) 0 (0.0) < 0.01 Diabetes 86 (25.2) 2 (4.3) < 0.01 Immunocompromise 14 (4.1) 0 (0.0) 0.39 PDD = patient-directed discharge, HIV = human immunodeficiency virus, HCV = hepatitis C virus [Insert Table 1 ] Clinical characteristics between the two cohorts are shown in Table 2 . The PDD cohort had a lower Pitt Bacteremia score [ 18 ] (1.0 versus 1.7; p = 0.05) and shorter median length of hospitalization (14 days versus 15 days; p = 0.04), but were more likely to demonstrate behavioral concerns during admission (47% versus 6%; p < 0.01). The PDD cohort was more likely to be infected with methicillin sensitive Staphylococcus aureus (MSSA) (51% versus 33%; p = 0.02) and methicillin resistant Staphylococcus aureus (MRSA) (28% versus 13%; p < 0.01), had a lower median intravenous (IV) antibiotic duration (14 versus 42 days; p < 0.01), but a higher percentage were discharged on oral antibiotics (53% versus 8%; p < 0.01). Table 2 Clinical characteristics of infective endocarditis episodes with or without patient-directed discharge Non-PDD (n = 342)(%) PDD (n = 47)(%) p-value Pitt Bacteremia score (SD) 1.7 (2.4) 1.0 (1.6) 0.05 Length of hospitalization – median (IQR) 15 (8–33) 14 (5–21) 0.04 Behavioral concern during admission 19 (5.6) 22 (46.8) < 0.01 Heart valves involved Tricuspid 72 (21.1) 22 (46.8) < 0.01 Pulmonic 4 (1.2) 0 (0.0) 1.00 Aortic 108 (31.6) 5 (10.6) < 0.01 Mitral 107 (31.3) 3 (6.4) < 0.01 Unknown 46 (13.5) 11 (23.4) 0.07 Paravalvular abscess 12 (3.5) 1 (2.1) 1.00 New heart failure from IE 64 (18.7) 4 (8.5) 0.10 Valve replacement surgery 75 (21.6) 2 (4.3) < 0.01 Orthopedic surgery/procedure for IE related metastatic infection 27 (7.9) 5 (10.6) 0.57 Microbiology MSSA 113 (33.0) 24 (51.1) 0.02 MRSA 43 (12.6) 13 (27.7) 0.01 Streptococcus viridans 31 (9.1) 2 (4.3) 0.40 Other Streptococcus species 62 (18.1) 4 (8.5) 0.14 Enterococcus faecalis 26 (7.6) 2 (4.3) 0.56 Enterococcus faecium 1 (0.3) 0 (0.0) 1.00 HACEK group 7 (2.1) 0 (0.0) 1.00 Other 71 (20.8) 5 (10.6) 0.12 Sites of metastatic infection Lung 75 (21.9) 19 (40.4) 0.01 Brain 78 (22.8) 4 (8.5) 0.02 Spine 17 (5.0) 2 (4.3) 1.00 Joint 31 (9.1) 5 (10.6) 0.79 Days of positive blood cultures, mean (SD) 2.7 (2.6) 3.3 (4.5) 0.523 IV antibiotic duration in days, median (IQR) 42 (30–43) 14 (5–21) < 0.01 Discharged on oral antibiotics 27 (8.1) 24 (53.3) < 0.01 Total days of antibiotics (IV and PO), median (IQR) 42 (32–44) 33 (15–44) 0.03 Number of IE related re-admissions within 24 months (SD) 0.3 (0.6) 1.1 (1.1) 1 PDD - - 17 (36.2) - PDD = patient-directed discharge, SD = standard deviation, IQR = interquartile range, IE = infective endocarditis, MSSA = methicillin susceptible Staphylococcus aureus , MRSA = methicillin resistant Staphylococcus aureus , HACEK = Haemophilus species, Aggregatibacter , Cardiobacterium , Eikenella , Kingella , IV = intravenous, PO = oral [Insert Table 2 ] Results of the primary and secondary outcomes are shown in Table 3 . We did not observe a statistically significant difference in mortality or IE-related mortality at any time point. Conversely, we did observe significantly higher rates of readmission among the PDD cohort at all four timepoints. For example, the 30-day readmission rate was markedly different between the groups (38% of PDD cohort versus 11% of non-PDD cohort; p < 0.01). For secondary outcomes, the PDD cohort was more likely to have a microbiologic failure (43% versus 6%, p < 0.01) and a change in organism causing bacteremia (40–18%, p < 0.01). There was a non-significant trend towards more treatment failure (43–29%, p = 0.06) in the PDD cohort. Table 3 Primary and secondary outcomes of infective endocarditis episodes with or without patient-directed discharge Non-PDD (n = 342)(%) PDD (n = 47)(%) p-value 30-day mortality 11 (3.2) 0 (0.0) 0.37 90-day mortality 20 (5.9) 0 (0.0) 0.15 1-year mortality 26 (7.6) 2 (4.3) 0.56 2-year mortality 30 (8.8) 2 (4.3) 0.40 30-day readmission 36 (10.5) 18 (38.3) < 0.01 90-day readmission 53 (15.5) 22 (46.8) < 0.01 1-year readmission 74 (21.6) 25 (53.2) < 0.01 2-year readmission 79 (23.1) 30 (63.8) < 0.01 Microbiologic failure 21 (6.1) 20 (42.6) < 0.01 Clinical failure 99 (29.0) 20 (42.6) 0.06 Additional heart valves involved 11 (3.2) 10 (21.3) < 0.01 New paravalvular abscess 2 (0.6) 4 (8.5) < 0.01 New heart failure from IE 13 (3.8) 8 (17.0) < 0.01 Need for valve replacement surgery 29 (8.4) 7 (14.9) 0.15 Need for an orthopedic procedure for an IE related metastatic site of infection 3 (0.9) 1 (2.1) 0.40 New metastatic infection to the lung 3 (0.9) 10 (21.3) < 0.01 New metastatic infection to the brain 2 (0.6) 0 (0.0) 1.00 New metastatic infection to the spine 1 (0.3) 2 (4.3) 0.04 New metastatic infection to a joint 1 (0.3) 2 (4.3) 0.04 A change in organism(s) present 63 (18.4) 19 (40.4) < 0.01 Total days of positive blood cultures, including sentinel and subsequent admissions 3.0 (3.0) 5.5 (7.6) < 0.01 PDD = patient-directed discharge, IE = infective endocarditis [Insert Table 3 ] Results of the primary and secondary outcomes depending on duration of intravenous and oral antibiotics are shown in Table 4 . Patients who received less than 42 days of intravenous antibiotics did have a higher mortality rate at 30 and 90 days. Patients who were treated with partial oral antibiotics, compared to all intravenous antibiotics, had higher readmission rates and a higher chance of microbiologic and clinical failure. Table 4 Primary and secondary outcomes of infective endocarditis episodes per duration of intravenous and oral antibiotics ≥ 42d IV abx (n = 235) ≥ 10d & <42d IV abx; ≥ 42d abx overall (n = 33) < 10d IV abx; ≥ 42d abx overall (n = 14) < 42d abx (n = 107) p-value # (%) # (%) # (%) # (%) 30-day mortality 3 (1.3) 0 (0.0) 0 (0.0) 8 (7.5) 0.02 90-day mortality 8 (3.4) 1 (3.0) 0 (0.0) 11 (10.3) 0.07 1-year mortality 12 (5.1) 3 (9.1) 0 (0.0) 13 (12.2) 0.09 2-year mortality 16 (6.8) 3 (9.1) 0 (0.0) 13 (12.2) 0.30 30-day readmission 25 (10.6) 14 (42.4) 10 (71.4) 5 (4.7) < 0.01 90-day readmission 42 (17.9) 16 (48.5) 11 (78.6) 6 (5.6) < 0.01 1-year readmission 59 (25.1) 19 (57.6) 12 (85.7) 9 (8.4) < 0.01 2-year readmission 64 (27.2) 21 (63.6) 13 (92.9) 11 (10.3) < 0.01 Microbiologic failure 22 (9.4) 9 (27.3) 8 (57.1) 2 (1.9) < 0.01 Clinical failure 47 (20.0) 12 (36.4) 12 (85.7) 48 (44.9) < 0.01 Experienced PDD 5 (2.1) 17 (51.5) 11 (78.6) 14 (13.1) < 0.01 D = day, IV = intravenous, abx = antibiotics Discussion In this study we assessed demographic, clinical, and outcome differences amongst patients with IE who did or did not undergo PDD. We found many important, statistically significant differences between these cohorts. Patients who experienced PDD were younger and more likely to be unhoused, on Medicaid, and to suffer from substance use disorder, a finding seen in prior literature. [ 13 ] However, these patients had significantly fewer chronic conditions. Despite receiving fewer days of IV antibiotics, the PDD cohort did not have higher mortality in the short or long term. However, they did have markedly higher readmission rates, approximately threefold higher at each time point compared to the non-PDD cohort. Additionally, they were more prone to microbiologic failure, new paravalvular abscess or heart failure from IE, new metastatic sites of infection, or a new organism present in blood cultures in subsequent admissions. We found that, independent of how many days of IV antibiotics patients received, patients discharged on oral antibiotics generally did worse. It is worth noting that outpatient compliance with prescribed oral medications was not well assessed in our study, and is likely below the strict compliance and monitoring observed in the POET trial, which found similar outcomes with oral vs parenteral antibiotics. [ 8 ] Our study showing worse outcomes may highlight a more real-world experience using oral antibiotics specifically in the PDD population, in which compliance may be low. Our results are in line with prior literature and show important new findings. Over the study period of 2010 to 2020, we found only 12% of our total IE population experienced PDD, which is less than the 20–29% seen in other studies. [ 11 , 13 ] Similar to prior literature, our PDD cohort had higher rates of intravenous drug use, was younger, and was more likely to be unhoused, on Medicaid, diagnosed with a psychiatric disease, and suffering from hepatitis C virus infection. [ 11 – 13 , 19 , 20 ] In contrast, while prior literature describes the PDD cohort as having more comorbidities, we found a markedly increased likelihood for the non-PDD cohort to have chronic conditions including chronic kidney disease, coronary artery disease, and diabetes, all of which significantly increase mortality in the general population. [ 21 – 23 ] The increased number of chronic conditions may reflect sicker patients with increased risk of mortality on admission than the PDD patients and may explain the lack of a difference in mortality outcomes between the two groups. [ 24 ] The lack of a mortality difference may also be explained by the higher rates of right-sided endocarditis and lower rates of systemic and central nervous system embolization in the PDD cohort. [ 25 ] Clinically, this study reflects the large overlap between patients experiencing PDD and PWID as those experiencing PDD are also more likely to have tricuspid valve involvement and MSSA or MRSA infection. [ 19 ] The increased rate of metastatic infection to the lung within the PDD cohort compared to the increased rate of metastatic infection to the brain in the non-PDD cohort is reflected in the literature. This pattern aligns physiologically, given the likelihood that patients experiencing PDD are more likely to have right-sided valvular disease. [ 13 ] The non-PDD cohort received a median of 42 days of intravenous antibiotics, which is consistent with IE treatment guidelines. [ 6 ] As expected, the PDD cohort’s median of 14 days of intravenous antibiotics falls well short of IE treatment guidelines. The percentage of the PDD cohort prescribed oral antibiotics at discharge is comparable to the just over 50% seen in prior studies. [ 9 ] Those receiving partial intravenous antibiotics in combination with oral antibiotics had generally worse outcomes in terms of readmission rates, microbiologic failure and clinical failure, in contrast to prior studies. [ 8 , 9 ] However, these studies have minimal MRSA and PWID in both study groups, which suggests a different population than ours. [ 8 , 9 ] Adherence to oral antibiotics was not assessed in this study, so we cannot determine what proportion of these cases of treatment failure resulted from true failure of oral antibiotics versus patient nonadherence to the medical plan. The study’s primary outcomes follow the findings of previous studies and help better characterize the increased risks of PDD. Readmission rates, mortality, and complications of IE are expected to increase in populations who fall short of receiving the recommended treatment duration. Readmission rates for those who underwent PDD increased along with the time point; well over half of the PDD cohort were readmitted by the two-year mark compared to less than a quarter of the non-PDD cohort. Moreover, of those readmitted in either cohort, the PDD cohort had significantly more complications of IE. Despite higher readmission rates and complications of IE on subsequent admissions, the PDD cohort conferred no statistically increased risk of mortality, even when studied out to two years from the sentinel admission. Although studies have shown PDD increases risk of 30-day mortality in general, [ 26 ] Appa et al. demonstrated patients with Staphylococcus aureus bacteremia who experienced PDD have no increased risk of mortality at one year compared to a standard discharge. [ 12 ] Our study builds upon these findings by examining other common bacterial causes of IE in addition to Staphylococcus aureus for a duration of two years with a similar result. However, in contrast to prior studies, our study revealed the increased risks for readmissions, microbiologic failure and clinical failure for patients receiving partial intravenous antibiotics combined with oral antibiotics. [ 8 , 9 ] The non-significant difference in mortality between patients with IE experiencing PDD versus non-PDD is likely due to multiple factors: the PDD population is younger by almost three decades, has fewer comorbidities and less critical illness on presentation, and has more right-sided disease. However, these patients do have more readmissions and complications of IE, which results in greater health care costs and morbidity. Limitations Our study has several limitations. The study involved a single center and was retrospective. Moreover, the population of patients who experienced PDD was relatively small compared to other studies, though it was much more granular in detail. [ 11 , 13 ] Our study population was majority Caucasian and non-Hispanic, which may limit the generalizability of these findings to other races and ethnicities, although this population does reflect the majority of patients with IE and PWID. [ 19 ] The study required an extensive medical chart review involving multiple investigators, which leaves the possibility that some of the data collected is incomplete or was variably reviewed, and some patients may have been lost to follow-up with outcomes not available to capture in the medical record. We mitigated this risk with multiple reviewers per patient. The PDD cohort, post-discharge, may have less medical contact than the non-PDD cohort, potentially resulting in more uncaptured outcomes in that cohort and a bias in our outcomes data, for which our study cannot account. Patient deaths discovered on chart review were not verified on an official death registry, so the mortality outcome data may be incomplete. Lastly, to characterize the study population comprehensively, many variables were compared and statistically analyzed, which could introduce bias into the findings deemed statistically significant. Conclusion In conclusion, our study demonstrates that patients who undergo PDD have significantly different baseline characteristics and are more likely to be readmitted and experience complications when compared to patients without PDD, but without differences in short- and long-term mortality. We found that patients discharged on oral antibiotics fared worse than those who remained on intravenous antibiotics, which is likely impacted by lower outpatient medication adherence in this population. Abbreviations IE = infective endocarditis POET = partial oral treatment of endocarditis AMA = against medical advice PDD = patient-directed discharges PWID = people who inject drugs UVM = University of Vermont IV = intravenous Declarations Ethics Approval and Consent to Participate : This study was approved and granted consent to participate by the University of Vermont Medical Center Institutional Review Board. Consent for Publication : This study does not include factors necessitating patient consent. Availability of Data and Materials : The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests: The authors declare that they have no competing interests. Funding : The authors declare that they have no funding. Author’s Contributions : KC substantially contributed to the conception, design of the work, the acquisition, analysis, interpretation of data, the creation of new software used in the work, drafting and substantially revised the work. YTH substantially contributed to the conception, design of the work, the acquisition, analysis, interpretation of data, and the creation of new software used in the work. TL substantially contributed to the design of the work, the acquisition, analysis, interpretation of data, and substantially revised the work. TH substantially contributed to the design of the work, the acquisition, analysis, interpretation of data, and drafted the work. MHW substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. AS substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. TT substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. SM substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. JL substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. AC substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. BT substantially contributed to the design of the work, the acquisition, analysis, interpretation of data, and substantially revised the work. AH substantially contributed to the conception, design of the work, the acquisition, analysis, interpretation of data, the creation of new software used in the work, and substantially revised the work. All authors have approved the submitted version of the manuscript. All authors have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Acknowledgements : Not applicable. References Hoen B, Duval X. Infective endocarditis. N Engl J Med. 2013;369(8):785. Sanaiha Y, Lyons R, Benharash P. Infective endocarditis in intravenous drug users. Trends Cardiovasc Med. 2020;30(8):491-7. Rajani R, Klein JL. Infective endocarditis: A contemporary update. Clin Med (Lond). 2020;20(1):31-5. 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Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-33. Olesen KKW, Madsen M, Lip GYH, Egholm G, Thim T, Jensen LO, et al. Coronary artery disease and risk of adverse cardiac events and stroke. Eur J Clin Invest. 2017;47(11):819-28. Gregg EW, Cheng YJ, Srinivasan M, Lin J, Geiss LS, Albright AL, Imperatore G. Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet. 2018;391(10138):2430-40. Battle SE, Shuping M, Withers S, Justo JA, Bookstaver PB, Al-Hasan MN. Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score. J Infect. 2022;84(2):131-5. Stavi V, Brandstaetter E, Sagy I, Sapunar S, Nevzorov R, Bartal C, Barski L. Comparison of Clinical Characteristics and Prognosis in Patients with Right- and Left-sided Infective Endocarditis. Rambam Maimonides Med J. 2019;10(1). Southern WN, Nahvi S, Arnsten JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012;125(6):594-602. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4797948","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343218903,"identity":"85808755-4c9a-4983-b8f1-1a483cd9230f","order_by":0,"name":"Kyle Crooker","email":"","orcid":"","institution":"Henry Ford Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kyle","middleName":"","lastName":"Crooker","suffix":""},{"id":343218904,"identity":"25d96a17-1c3f-494a-b678-34fd757a6f42","order_by":1,"name":"YuTing He","email":"","orcid":"","institution":"Northeast Medical Services","correspondingAuthor":false,"prefix":"","firstName":"YuTing","middleName":"","lastName":"He","suffix":""},{"id":343218905,"identity":"8042754e-844a-4780-879a-62fab441d0fa","order_by":2,"name":"Tim Lahey","email":"","orcid":"","institution":"University of Vermont Medical Center, University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Tim","middleName":"","lastName":"Lahey","suffix":""},{"id":343218906,"identity":"d28cbd44-098b-456e-a7d9-836ba0f0571b","order_by":3,"name":"Tess Hickey","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Tess","middleName":"","lastName":"Hickey","suffix":""},{"id":343218907,"identity":"bf720ba7-a6d8-4c60-99d1-15743e75e453","order_by":4,"name":"Max HoddWells","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Max","middleName":"","lastName":"HoddWells","suffix":""},{"id":343218908,"identity":"75a95445-6533-4229-abb7-c2a013a0b9e8","order_by":5,"name":"Ashwini Sarathy","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Ashwini","middleName":"","lastName":"Sarathy","suffix":""},{"id":343218909,"identity":"d7d3bfd7-2d83-4036-ba86-18a69bfb7d4d","order_by":6,"name":"Torrance Teng","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Torrance","middleName":"","lastName":"Teng","suffix":""},{"id":343218910,"identity":"1c1ebba3-fa55-4afd-9d7a-ff2a9e540efe","order_by":7,"name":"Sean Muniz","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Sean","middleName":"","lastName":"Muniz","suffix":""},{"id":343218911,"identity":"f7cf185b-fd77-48f3-8917-fefef6858197","order_by":8,"name":"Jennifer Lor","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Lor","suffix":""},{"id":343218912,"identity":"3e180df8-e003-44cb-8b0c-f566a5d81601","order_by":9,"name":"Amy Chang","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Amy","middleName":"","lastName":"Chang","suffix":""},{"id":343218913,"identity":"0ae50c9b-7705-4b17-b95c-c0c32830bec6","order_by":10,"name":"Bradley J. Tompkins","email":"","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":false,"prefix":"","firstName":"Bradley","middleName":"J.","lastName":"Tompkins","suffix":""},{"id":343218914,"identity":"a93bfb0b-2306-4b51-bf61-865bc1e255cb","order_by":11,"name":"Andrew Hale","email":"data:image/png;base64,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","orcid":"","institution":"Larner College of Medicine at the University of Vermont","correspondingAuthor":true,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Hale","suffix":""}],"badges":[],"createdAt":"2024-07-24 22:57:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4797948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4797948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68560257,"identity":"2160fdd0-447c-4785-906c-2e280f66b76b","added_by":"auto","created_at":"2024-11-08 14:09:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":808154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4797948/v1/f6ae2bba-6bf6-4920-91fb-27cf75a06d9b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Short- and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge: A Retrospective Cohort Study","fulltext":[{"header":"Background","content":"\u003cp\u003eInfective endocarditis (IE) is a lethal infection that requires intensive multidisciplinary hospital care at diagnosis. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Mortality for patients experiencing IE approaches 30% at 30 days. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The healthcare burden of IE has recently been increasing; hospitalizations have increased from 0.32 to 0.75 cases per 100,000 hospitalizations in the United States over the last twenty years. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe current standard of care for IE is 4\u0026ndash;6 weeks of culture-directed intravenous antibiotics, [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and surgical intervention is required in 20\u0026ndash;50% of cases. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] This standard of care typically involves an initial hospital-based phase of care followed by outpatient parenteral antibiotics, although this approach is evolving in response to the partial oral treatment of endocarditis (POET) and other clinical studies suggesting that some patients can be cured after an early transition to oral antibiotics. [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePatients who leave the hospital prematurely are an important, challenging, and growing subset of the IE population. Patient-directed (formerly called against medical advice or AMA) discharges (PDD) are higher in people who inject drugs (PWID), as is IE, and PDDs are rising in this population. Prior data suggest 14\u0026ndash;29% of admissions among PWID with IE result in PDD, compared to 1.9% in patients with IE and no intravenous drug use, and that PDD in PWID with IE increased 12% per year from 2010 to 2015. [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Furthermore, in a national database from 2016\u0026ndash;2019, 89% of 4,310 patients with IE who had a PDD were identified as PWID. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePrior data has also suggested that patients with IE who have a PDD have worse outcomes. Thirty-day readmission rates in this group approach 50%, as opposed to 21% among patients with IE without a PDD. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Rates of recurrent bacteremia, new emboli, and overall mortality have also been shown to be significantly higher among IE patients with PDD. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGiven the growth of the PDD population and increasing prevalence of IE, and new data suggesting that some patients can be cured after an early transition to oral therapy, we assessed the short- and long-term clinical outcomes in patients with IE who do and do not undergo a PDD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Setting, Population, and Ethical Approval\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study in adult patients admitted to the University of Vermont (UVM) Medical Center, Burlington, Vermont, from 2010\u0026ndash;2020, comparing outcomes between those who did or did not undergo a PDD. UVM Medical Center is a tertiary care academic hospital with 620 licensed beds and serves an urban and rural population in Vermont and New York of approximately one million persons. We included all patients over 18 years of age with infective endocarditis, as identified by ICD (International Classification of Diseases) 10 codes and excluded patients from the analyses if they did not meet the definition of endocarditis as defined by the modified Duke criteria and IDSA (Infectious Diseases Society of America) guidelines. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Patients with endocarditis from a fungi or fastidious organism, such as from Bartonella or Coxiella, were excluded from certain parts of the analysis such as length of antibiotic treatment and length of positive blood cultures, given significant expected differences relative to normal bacterial IE. At least two members of the study team performed manual chart review of each patient\u0026rsquo;s demographic characteristics, clinical findings and ultimate outcome. All reviewers received training, and differences were adjudicated by a third physician review. The study was approved by the UVM Institutional Review Board.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003eWe compared baseline demographic data, comorbidities, and clinical details between patients who did or did not undergo PDD. Our primary outcomes were 30-day, 90-day, 1-year, and 2-year mortality, IE-related mortality, and IE-related readmission rates. Secondary outcomes included microbiologic failure (recurrence of bacteremia from the original organism), treatment failure, (death, new paravalvular abscess, new heart failure from IE, new valve replacement, new IE-related orthopedic procedure, or a new metastatic site of infection), and a change in the organism causing bacteremia.\u003c/p\u003e \u003cp\u003eWe also compared the primary and secondary outcomes among patients depending on the length of intravenous and oral antibiotics they received to assess what combinations approximated the outcomes of the current standard of care, which is typically 42 days of intravenous antibiotics. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eWe collected study data into a REDCap electronic database [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and conducted statistical analyses in Stata [Stata 16.1, Stata Corp, LLC. College Station, TX]. We compared demographics, clinical findings and outcomes between patients who experienced PDD and those who did not via Wilcoxon rank sum test for continuous variables and via chi-square analysis or Fisher\u0026rsquo;s exact test for categorical variables. Odds ratios were calculated via logistic regression.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e We included 389 patients in our analyses based on inclusion and exclusion criteria. Demographic characteristics between groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Notably, the PDD cohort differed from the non-PDD cohort in several important ways: they were younger (average age 33 years versus 61 years; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), more likely to have Medicaid for insurance (75% versus 28%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and more likely to experience homelessness (17% versus 6%; p\u0026thinsp;=\u0026thinsp;0.01). The PDD cohort was more likely to smoke tobacco (89% versus 33%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and use intravenous drugs (87% versus 27%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The PDD cohort was more likely to suffer from hepatitis C virus (72% versus 27%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and have a history of psychiatric disease (53% versus 33%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but otherwise the PDD cohort was less likely to suffer from chronic diseases including chronic kidney disease (6% versus 22%; p\u0026thinsp;=\u0026thinsp;0.01), coronary artery disease (2% versus 25%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), pre-existing prosthetic heart valve (0% versus 22%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), chronic heart failure (0% versus 16%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and diabetes (4% versus 25%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline demographics between patients who did or did not undergo patient-directed discharge\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNon-PDD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;342)(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePDD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)(interquartile range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(39\u0026ndash;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(28\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender: female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRace: Caucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(96.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEthnicity: non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInsurance: Medicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHomelessness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTobacco use disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAlcohol use disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntravenous drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOther substance use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarijuana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMethamphetamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCocaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChronic kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHIV infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHCV, positive serology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(71.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePsychiatric disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePre-existing prosthetic heart valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(24.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChronic heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eImmunocompromise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ePDD\u0026thinsp;=\u0026thinsp;patient-directed discharge, HIV\u0026thinsp;=\u0026thinsp;human immunodeficiency virus, HCV\u0026thinsp;=\u0026thinsp;hepatitis C virus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eClinical characteristics between the two cohorts are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The PDD cohort had a lower Pitt Bacteremia score [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] (1.0 versus 1.7; p\u0026thinsp;=\u0026thinsp;0.05) and shorter median length of hospitalization (14 days versus 15 days; p\u0026thinsp;=\u0026thinsp;0.04), but were more likely to demonstrate behavioral concerns during admission (47% versus 6%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The PDD cohort was more likely to be infected with methicillin sensitive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MSSA) (51% versus 33%; p\u0026thinsp;=\u0026thinsp;0.02) and methicillin resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) (28% versus 13%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), had a lower median intravenous (IV) antibiotic duration (14 versus 42 days; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but a higher percentage were discharged on oral antibiotics (53% versus 8%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of infective endocarditis episodes with or without patient-directed discharge\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNon-PDD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;342)(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePDD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePitt Bacteremia score (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eLength of hospitalization \u0026ndash; median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(8\u0026ndash;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(5\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eBehavioral concern during admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eHeart valves involved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTricuspid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePulmonic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAortic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMitral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eParavalvular abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNew heart failure from IE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eValve replacement surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eOrthopedic surgery/procedure for IE related metastatic infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eMicrobiology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMSSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMRSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eStreptococcus viridans\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOther Streptococcus species\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEnterococcus faecalis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEnterococcus faecium\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHACEK group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSites of metastatic infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSpine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eJoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDays of positive blood cultures, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eIV antibiotic duration in days, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(30\u0026ndash;43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(5\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDischarged on oral antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTotal days of antibiotics (IV and PO), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(32\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(15\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNumber of IE related re-admissions within 24 months (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNumber of PDDs, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNumber of patients with \u0026gt;\u0026thinsp;1 PDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePDD\u0026thinsp;=\u0026thinsp;patient-directed discharge, SD\u0026thinsp;=\u0026thinsp;standard deviation, IQR\u0026thinsp;=\u0026thinsp;interquartile range, IE\u0026thinsp;=\u0026thinsp;infective endocarditis, MSSA\u0026thinsp;=\u0026thinsp;methicillin susceptible \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, MRSA\u0026thinsp;=\u0026thinsp;methicillin resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, HACEK\u0026thinsp;=\u0026thinsp;\u003cem\u003eHaemophilus\u003c/em\u003e species, \u003cem\u003eAggregatibacter\u003c/em\u003e, \u003cem\u003eCardiobacterium\u003c/em\u003e, \u003cem\u003eEikenella\u003c/em\u003e, \u003cem\u003eKingella\u003c/em\u003e, IV\u0026thinsp;=\u0026thinsp;intravenous, PO\u0026thinsp;=\u0026thinsp;oral\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eResults of the primary and secondary outcomes are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. We did not observe a statistically significant difference in mortality or IE-related mortality at any time point. Conversely, we did observe significantly higher rates of readmission among the PDD cohort at all four timepoints. For example, the 30-day readmission rate was markedly different between the groups (38% of PDD cohort versus 11% of non-PDD cohort; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). For secondary outcomes, the PDD cohort was more likely to have a microbiologic failure (43% versus 6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and a change in organism causing bacteremia (40\u0026ndash;18%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). There was a non-significant trend towards more treatment failure (43\u0026ndash;29%, p\u0026thinsp;=\u0026thinsp;0.06) in the PDD cohort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary and secondary outcomes of infective endocarditis episodes with or without patient-directed discharge\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eNon-PDD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;342)(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003ePDD\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e90-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1-year mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2-year mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e30-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e90-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e1-year readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2-year readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMicrobiologic failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eClinical failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAdditional heart valves involved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNew paravalvular abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNew heart failure from IE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNeed for valve replacement surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNeed for an orthopedic procedure for an IE related metastatic site of infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNew metastatic infection to the lung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNew metastatic infection to the brain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNew metastatic infection to the spine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNew metastatic infection to a joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eA change in organism(s) present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eTotal days of positive blood cultures, including sentinel and subsequent admissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003e(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003ePDD\u0026thinsp;=\u0026thinsp;patient-directed discharge, IE\u0026thinsp;=\u0026thinsp;infective endocarditis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eResults of the primary and secondary outcomes depending on duration of intravenous and oral antibiotics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Patients who received less than 42 days of intravenous antibiotics did have a higher mortality rate at 30 and 90 days. Patients who were treated with partial oral antibiotics, compared to all intravenous antibiotics, had higher readmission rates and a higher chance of microbiologic and clinical failure.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary and secondary outcomes of infective endocarditis episodes per duration of intravenous and oral antibiotics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;42d IV abx (n\u0026thinsp;=\u0026thinsp;235)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10d \u0026amp; \u0026lt;42d IV abx; \u0026ge; 42d abx overall (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10d IV abx;\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;42d abx overall (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;42d abx\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-year mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-year mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-year readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-year readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrobiologic failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperienced PDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eD\u0026thinsp;=\u0026thinsp;day, IV\u0026thinsp;=\u0026thinsp;intravenous, abx\u0026thinsp;=\u0026thinsp;antibiotics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study we assessed demographic, clinical, and outcome differences amongst patients with IE who did or did not undergo PDD. We found many important, statistically significant differences between these cohorts. Patients who experienced PDD were younger and more likely to be unhoused, on Medicaid, and to suffer from substance use disorder, a finding seen in prior literature. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] However, these patients had significantly fewer chronic conditions. Despite receiving fewer days of IV antibiotics, the PDD cohort did not have higher mortality in the short or long term. However, they did have markedly higher readmission rates, approximately threefold higher at each time point compared to the non-PDD cohort. Additionally, they were more prone to microbiologic failure, new paravalvular abscess or heart failure from IE, new metastatic sites of infection, or a new organism present in blood cultures in subsequent admissions. We found that, independent of how many days of IV antibiotics patients received, patients discharged on oral antibiotics generally did worse. It is worth noting that outpatient compliance with prescribed oral medications was not well assessed in our study, and is likely below the strict compliance and monitoring observed in the POET trial, which found similar outcomes with oral vs parenteral antibiotics. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Our study showing worse outcomes may highlight a more real-world experience using oral antibiotics specifically in the PDD population, in which compliance may be low.\u003c/p\u003e \u003cp\u003eOur results are in line with prior literature and show important new findings. Over the study period of 2010 to 2020, we found only 12% of our total IE population experienced PDD, which is less than the 20\u0026ndash;29% seen in other studies. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Similar to prior literature, our PDD cohort had higher rates of intravenous drug use, was younger, and was more likely to be unhoused, on Medicaid, diagnosed with a psychiatric disease, and suffering from hepatitis C virus infection. [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] In contrast, while prior literature describes the PDD cohort as having more comorbidities, we found a markedly increased likelihood for the non-PDD cohort to have chronic conditions including chronic kidney disease, coronary artery disease, and diabetes, all of which significantly increase mortality in the general population. [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] The increased number of chronic conditions may reflect sicker patients with increased risk of mortality on admission than the PDD patients and may explain the lack of a difference in mortality outcomes between the two groups. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] The lack of a mortality difference may also be explained by the higher rates of right-sided endocarditis and lower rates of systemic and central nervous system embolization in the PDD cohort. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eClinically, this study reflects the large overlap between patients experiencing PDD and PWID as those experiencing PDD are also more likely to have tricuspid valve involvement and MSSA or MRSA infection. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] The increased rate of metastatic infection to the lung within the PDD cohort compared to the increased rate of metastatic infection to the brain in the non-PDD cohort is reflected in the literature. This pattern aligns physiologically, given the likelihood that patients experiencing PDD are more likely to have right-sided valvular disease. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The non-PDD cohort received a median of 42 days of intravenous antibiotics, which is consistent with IE treatment guidelines. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] As expected, the PDD cohort\u0026rsquo;s median of 14 days of intravenous antibiotics falls well short of IE treatment guidelines. The percentage of the PDD cohort prescribed oral antibiotics at discharge is comparable to the just over 50% seen in prior studies. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Those receiving partial intravenous antibiotics in combination with oral antibiotics had generally worse outcomes in terms of readmission rates, microbiologic failure and clinical failure, in contrast to prior studies. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] However, these studies have minimal MRSA and PWID in both study groups, which suggests a different population than ours. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Adherence to oral antibiotics was not assessed in this study, so we cannot determine what proportion of these cases of treatment failure resulted from true failure of oral antibiotics versus patient nonadherence to the medical plan.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s primary outcomes follow the findings of previous studies and help better characterize the increased risks of PDD. Readmission rates, mortality, and complications of IE are expected to increase in populations who fall short of receiving the recommended treatment duration. Readmission rates for those who underwent PDD increased along with the time point; well over half of the PDD cohort were readmitted by the two-year mark compared to less than a quarter of the non-PDD cohort. Moreover, of those readmitted in either cohort, the PDD cohort had significantly more complications of IE. Despite higher readmission rates and complications of IE on subsequent admissions, the PDD cohort conferred no statistically increased risk of mortality, even when studied out to two years from the sentinel admission. Although studies have shown PDD increases risk of 30-day mortality in general, [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Appa et al. demonstrated patients with \u003cem\u003eStaphylococcus aureus\u003c/em\u003e bacteremia who experienced PDD have no increased risk of mortality at one year compared to a standard discharge. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Our study builds upon these findings by examining other common bacterial causes of IE in addition to \u003cem\u003eStaphylococcus aureus\u003c/em\u003e for a duration of two years with a similar result. However, in contrast to prior studies, our study revealed the increased risks for readmissions, microbiologic failure and clinical failure for patients receiving partial intravenous antibiotics combined with oral antibiotics. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe non-significant difference in mortality between patients with IE experiencing PDD versus non-PDD is likely due to multiple factors: the PDD population is younger by almost three decades, has fewer comorbidities and less critical illness on presentation, and has more right-sided disease. However, these patients do have more readmissions and complications of IE, which results in greater health care costs and morbidity.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur study has several limitations. The study involved a single center and was retrospective. Moreover, the population of patients who experienced PDD was relatively small compared to other studies, though it was much more granular in detail. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Our study population was majority Caucasian and non-Hispanic, which may limit the generalizability of these findings to other races and ethnicities, although this population does reflect the majority of patients with IE and PWID. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] The study required an extensive medical chart review involving multiple investigators, which leaves the possibility that some of the data collected is incomplete or was variably reviewed, and some patients may have been lost to follow-up with outcomes not available to capture in the medical record. We mitigated this risk with multiple reviewers per patient. The PDD cohort, post-discharge, may have less medical contact than the non-PDD cohort, potentially resulting in more uncaptured outcomes in that cohort and a bias in our outcomes data, for which our study cannot account. Patient deaths discovered on chart review were not verified on an official death registry, so the mortality outcome data may be incomplete. Lastly, to characterize the study population comprehensively, many variables were compared and statistically analyzed, which could introduce bias into the findings deemed statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study demonstrates that patients who undergo PDD have significantly different baseline characteristics and are more likely to be readmitted and experience complications when compared to patients without PDD, but without differences in short- and long-term mortality. We found that patients discharged on oral antibiotics fared worse than those who remained on intravenous antibiotics, which is likely impacted by lower outpatient medication adherence in this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIE = infective endocarditis\u003c/p\u003e\n\u003cp\u003ePOET = partial oral treatment of endocarditis\u003c/p\u003e\n\u003cp\u003eAMA = against medical advice\u003c/p\u003e\n\u003cp\u003ePDD = patient-directed discharges\u003c/p\u003e\n\u003cp\u003ePWID = people who inject drugs\u003c/p\u003e\n\u003cp\u003eUVM = University of Vermont\u003c/p\u003e\n\u003cp\u003eIV = intravenous\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e: This study was approved and granted consent to participate by the University of Vermont Medical Center Institutional Review Board.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: This study does not include factors necessitating patient consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: The authors declare that they have no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contributions\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKC substantially contributed to the conception, design of the work, the acquisition, analysis, interpretation of data, the creation of new software used in the work, drafting and substantially revised the work. YTH substantially contributed to the conception, design of the work, the acquisition, analysis, interpretation of data, and the creation of new software used in the work. TL substantially contributed to the design of the work, the acquisition, analysis, interpretation of data, and substantially revised the work. TH substantially contributed to the design of the work, the acquisition, analysis, interpretation of data, and drafted the work. MHW substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. AS substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. TT substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. SM substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. JL substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. AC substantially contributed to the design of the work, the acquisition, analysis, and interpretation of data. BT substantially contributed to the design of the work, the acquisition, analysis, interpretation of data, and substantially revised the work. AH substantially contributed to the conception, design of the work, the acquisition, analysis, interpretation of data, the creation of new software used in the work, and substantially revised the work. All authors have approved the submitted version of the manuscript. All authors have agreed both to be personally accountable for the author\u0026apos;s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHoen B, Duval X. Infective endocarditis. N Engl J Med. 2013;369(8):785.\u003c/li\u003e\n\u003cli\u003eSanaiha Y, Lyons R, Benharash P. Infective endocarditis in intravenous drug users. Trends Cardiovasc Med. 2020;30(8):491-7.\u003c/li\u003e\n\u003cli\u003eRajani R, Klein JL. Infective endocarditis: A contemporary update. Clin Med (Lond). 2020;20(1):31-5.\u003c/li\u003e\n\u003cli\u003eAlkhouli MA, Alqahtani F, Alhajji M, Berzingi CO, Sohail MR. 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Open Forum Infect Dis. 2022;9(2):ofab633.\u003c/li\u003e\n\u003cli\u003eKimmel SD, Kim JH, Kalesan B, Samet JH, Walley AY, Larochelle MR. Against Medical Advice Discharges in Injection and Non-injection Drug Use-associated Infective Endocarditis: A Nationwide Cohort Study. Clin Infect Dis. 2021;73(9):e2484-e92.\u003c/li\u003e\n\u003cli\u003eAppa A, Adamo M, Le S, Davis J, Winston L, Doernberg SB, et al. Patient-Directed Discharges Among Persons Who Use Drugs Hospitalized with Invasive Staphylococcus aureus Infections: Opportunities for Improvement. Am J Med. 2022;135(1):91-6.\u003c/li\u003e\n\u003cli\u003eMishra AK, Abraham BM, Sahu KK, George AA, Sargent J, Kranis MJ, et al. Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis. J Patient Saf. 2022;18(8):756-9.\u003c/li\u003e\n\u003cli\u003eThyagaturu HS, Bolton A, Thangjui S, Kumar A, Shah K, Bondi G, et al. Effect of leaving against medical advice on 30-day infective endocarditis readmissions. Expert Rev Cardiovasc Ther. 2022;20(9):773-81.\u003c/li\u003e\n\u003cli\u003eSchranz AJ, Tak C, Wu LT, Chu VH, Wohl DA, Rosen DL. The Impact of Discharge Against Medical Advice on Readmission After Opioid Use Disorder-Associated Infective Endocarditis: a National Cohort Study. Journal of general internal medicine. 2022.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u0026apos;Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.\u003c/li\u003e\n\u003cli\u003eAl-Hasan MN, Baddour LM. 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Eur J Clin Invest. 2017;47(11):819-28.\u003c/li\u003e\n\u003cli\u003eGregg EW, Cheng YJ, Srinivasan M, Lin J, Geiss LS, Albright AL, Imperatore G. Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet. 2018;391(10138):2430-40.\u003c/li\u003e\n\u003cli\u003eBattle SE, Shuping M, Withers S, Justo JA, Bookstaver PB, Al-Hasan MN. Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score. J Infect. 2022;84(2):131-5.\u003c/li\u003e\n\u003cli\u003eStavi V, Brandstaetter E, Sagy I, Sapunar S, Nevzorov R, Bartal C, Barski L. Comparison of Clinical Characteristics and Prognosis in Patients with Right- and Left-sided Infective Endocarditis. Rambam Maimonides Med J. 2019;10(1).\u003c/li\u003e\n\u003cli\u003eSouthern WN, Nahvi S, Arnsten JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012;125(6):594-602.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"infective endocarditis, patient-directed discharge, against medical advice","lastPublishedDoi":"10.21203/rs.3.rs-4797948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4797948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThere is an increase of patients with infective endocarditis who undergo patient-directed discharge prior to completion of the recommended duration of parenteral antibiotics. Outcomes of patients with infective endocarditis who do or do not undergo patient-directed discharge have not been clearly elucidated.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was done on all adult patients with infective endocarditis admitted at a single center between 2010\u0026ndash;2020 who did or did not undergo patient-directed discharge. The authors compared baseline characteristics as well as 30-day, 90-day, 1-year, and 2-year outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 389 patients were included, with 47 in the patient-directed discharge cohort and 342 in the non-patient-directed discharge cohort. The patient-directed discharge cohort was younger and more likely to use intravenous drugs, but less likely to suffer from chronic diseases. The patient-directed discharge cohort was more likely to be infected with \u003cem\u003eS. aureus\u003c/em\u003e, to experience right-sided valvular disease, and to receive less parenteral antibiotics. While there was no significant difference in mortality, the patient-directed discharge cohort had increased risk of complications.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePatients with infective endocarditis who undergo patient-directed discharge have significantly different baseline characteristics and are more likely to have complications of infective endocarditis when compared to non-patient-directed discharge, but with no significant difference in mortality.\u003c/p\u003e","manuscriptTitle":"Short- and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-22 07:00:05","doi":"10.21203/rs.3.rs-4797948/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"64aaa085-355e-4bd2-8856-9521a9377099","owner":[],"postedDate":"August 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-08T14:08:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-22 07:00:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4797948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4797948","identity":"rs-4797948","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}