Which trial do we need? Long-acting glycopeptides versus oral antibiotics for infective endocarditis in patients with substance use disorder

Clin Microbiol Infect

2023 Apr 10;S1198-743X(23)00160-X.. Online ahead of print

PMID: 37044275

DOI: 10.1016/j.cmi.2023.04.005

Abstract

A 45-year-old woman with both opioid and methamphetamine use disorders is hospitalized for tricuspid valve infective endocarditis (IE) due to methicillin-susceptible Staphylococcus aureus. Blood cultures cleared on hospital day 3. She has septic pulmonary emboli with two small pulmonary abscesses that do not require drainage. She had a two-year history of recovery while on methadone. One month prior to hospitalization, she started injecting fentanyl and methamphetamine after the death of a family member. On day 6 of hospitalization, she says she is fearful of losing her housing and job and desires early hospital discharge. The clinical team faced barriers in arranging outpatient parenteral antibiotic therapy (OPAT). She does not want to go to a facility to receive intravenous (IV) antibiotics. The clinical question is: What is the best option to treat IE, considering that the recommended IV antibiotic treatment duration for native valve IE due to S. aureus is 4–6 weeks...