Partial Oral Versus Intravenous Antibiotic Therapy for Endocarditis With Management by a Multidisciplinary Team: A Retrospective Cohort Study
Bibliographic record
Abstract
Abstract Background Despite trial data supporting oral stepdown therapy for infective endocarditis (IE), its use remains limited, especially in North America. We evaluated outcomes of patients with IE managed by a multidisciplinary team and treated with either intravenous (IV) or partial oral antibiotics. Methods This was a single-center retrospective study of patients with definite IE identified from an institutional registry between 7 September 2021 and 1 March 2025. Clinical and outcomes data were analyzed using multivariable logistic regression. Results Of 236 patients, 143 received IV therapy alone and 93 were transitioned to partial oral therapy. Baseline characteristics were similar, though valve surgery was more frequent in the oral group (40.9% vs 28.0%; P = .04). There were no significant differences in 90-day relapsed infection (0.7% vs 2.2%; P = .32), 90-day all-cause mortality (2.8% vs 6.5%; P = .17), or the composite of both outcomes (3.5% vs 8.6%; P = .09). There was no difference in relapsed infection or all-cause mortality at 90 days for patients with methicillin-resistant Staphylococcus aureus transitioned to oral therapy. In multivariable analysis, oral therapy was not associated with increased 90-day mortality (odds ratio [OR], 1.72 [95% confidence interval {CI} .41–7.24]; P = .46). Independent predictors of mortality included older age (OR, 1.06 per year [95% CI, 1.00–1.13]; P < .001), acute heart failure (OR, 18.61), and discharge before medically advised (OR, 8.60). Conclusions In selected patients managed by a multidisciplinary team, partial oral therapy for IE appears to be safe and effective, with outcomes comparable to exclusive IV treatment, consistent with European guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".