J Antimicrob Chemother. 2026 Jul 2;81(8):dkag222. doi: 10.1093/jac/dkag222.
ABSTRACT
BACKGROUND: The post-surgical duration of antibiotic treatment for patients with active infective endocarditis (IE), receiving heart valve surgery is uncertain. We aimed to assess the antibiotic treatment received by, and outcomes of, patients with active Enterococcus faecalis IE (EFIE) receiving valve surgery. We also sought to assess whether a subset of patients with EFIE receiving valve surgery were cured with shorter durations of post-surgical antibiotic treatment.
PATIENTS AND METHODS: This was a national retrospective observational cohort study assessing adults (≥15 years) receiving valve surgery from one of five cardiothoracic surgical units during active EFIE over a 20-year period, 2004-2023, in Aotearoa New Zealand. We compared the post-valve surgery antibiotic duration and outcomes of patients at Te Toka Tumai Auckland, which used a protocol aiming to limit post-valve surgery antibiotic duration, with those at the other four surgical units combined.
RESULTS: One hundred and 10 patients received valve surgery during an EFIE episode. Comparing those who received treatment at Te Toka Tumai Auckland with the other four surgical units combined, the Te Toka Tumai Auckland group received a median of 14 days less post-surgical antibiotic duration, 28 days versus 42 days, (P = 0.004); there were no relapses in either group and no difference in survival.
CONCLUSIONS: No relapsed EFIE occurred and there was no difference in survival when comparing the groups that received shorter versus longer post-surgical antibiotic durations. Shorter antibiotic durations have significant benefits. Prospective studies are required to provide clinicians with increased assurance regarding the safety of this approach.
PMID:42424500 | DOI:10.1093/jac/dkag222