Specialty-Related Differences in Adherence to Antibiotic Therapy Guidelines for Infective Endocarditis in Older Patients.

Background/

Objectives

Infective endocarditis (IE) is a condition with complex management, and several guidelines exist to guide clinicians. Adherence to these recommendations varies and could even be described as poor. The aim of this study was to determine whether the medical specialty of the unit that initiated first-line treatment for IE was associated with risk factors of non-adherence to the 2015 ESC treatment guidelines in a population of patients aged 75 years and over. Method: We analysed data from patients with possible or definite IE included in the ENDOLA cohort, an observational, longitudinal, retrospective, nationwide, real-life cohort study involving 34 French hospitals. Logistic regression was performed using a manual stepwise method to identify variables independently associated with non-compliance of antibiotic treatment of IE with the recommendations of the 2015 ESC guidelines.

Results

In total, 899 patients were included (Mean age: 83 ± 5 years, mean Charlson comorbidity score: 3 ± 2). The distribution across the medical units was 51.9% infectious disease (n = 467), 19.8% geriatric ward (n = 178), 18.5% cardiology (n = 166), and 9.8% other wards (n = 88). Patients admitted to geriatric wards were older (p < 0.0001) and were more likely to be dependent for activities of daily living (p < 0.0001). Admission to a geriatric unit was associated with a higher rate of non-compliance with the ESC guidelines (OR 1.6 (1.1-2.4); p: 0.03); prescriptions by cardiologists were more often in compliance with the guidelines (OR 0.6 (0.4-1.0); p: 0.04).

Conclusions

The first-line antibiotic treatment prescribed for IE varies considerably depending on the unit responsible for providing care at the time of initial admission.