Loading ...

TOPLINE:

In clinically stable patients with suspected or confirmed infective endocarditis (IE), deferring antimicrobial treatment until blood culture results were available was not associated with 30-day mortality or worse clinical outcomes compared with immediate antimicrobial treatment.

METHODOLOGY:

• Researchers in Switzerland conducted a retrospective study at two university hospitals to assess the impact of delayed antimicrobial treatment on survival among patients with suspected and confirmed IE.
• They reviewed 1230 bacteraemia episodes with suspected IE; immediate antimicrobial treatment was initiated in 675 episodes, and the treatment was delayed until preliminary blood culture results were available in 555 episodes.
• The outcome assessed was 30-day mortality, and the 30-day composite primary endpoint included mortality, new embolic events, or new bone and joint infections in patients with suspected or confirmed IE.

TAKEAWAY:

• Overall, 30-day mortality was not significantly different between immediate and delayed treatment groups (5% vs 5%; log-rank P = .854).
• Among 597 episodes with confirmed IE, neither 30-day mortality (log-rank P = .174) nor the 30-day composite primary endpoint (log-rank P = .263) differed significantly between the immediate and delayed treatment groups.
• Independent predictors of 30-day mortality were a Charlson Comorbidity Index of > 4 and persistent bacteraemia; the immediate initiation of antimicrobial therapy was not associated with reduced mortality.

IN PRACTICE:

"[The study] findings advocate for a careful, patient-centered approach to initiating AT [antimicrobial treatment] in clinically stable patients with suspected IE, particularly in cases with diagnostic uncertainty helping to avoid unnecessary use of broad-spectrum antimicrobials," the authors wrote.

SOURCE:

This study was led by Elisavet Stavropoulou, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. It was published online on October 07, 2025, in Open Forum Infectious Diseases.

LIMITATIONS:

This study was conducted in a single healthcare system, and because the identification of rapid species relied on matrix-assisted laser desorption/ionisation time of flight, the findings may not be applicable to other settings. Selection bias was present, and residual confounding from unmeasured variables cannot be ruled out. Additionally, regional differences in clinical practice and antimicrobial stewardship policies may have affected the results.

DISCLOSURES:

This study received support through grants from the Swiss National Science Foundation, Swiss Heart Foundation, and Vaudois Foundation for Interventional Cardiology. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.