Partial Oral Versus Intravenous Antibiotic Therapy for Endocarditis With Management by a Multidisciplinary Team: A Retrospective Cohort Study

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.