2398. Short and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge

• Published in: Open forum infectious diseases 2023-11, Vol.10 (Supplement_2)
• Main Authors: Crooker, Kyle, He, YuTing, Hickey, Tess, HoddWells, Max, Sarathy, Ashwini, Teng, Torrance, Muniz, Sean, Lor, Jennifer, Chang, Amy, Tompkins, Bradley, HALE, A N D R E W
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad500.2018

Abstract Background Infective endocarditis (IE) results in high morbidity and mortality. Guidelines for IE recommend prolonged intravenous antibiotics that can result in extended hospitalization, but some patients experience patient-directed discharges (PDD) prior to completion. There is a current lack of literature clearly defining long-term outcomes and optimal treatment strategies in patients with IE who experience PDD. Methods This is a retrospective cohort study comparing outcomes of adult patients with infective endocarditis at a single center from 2010 to 2020 who experienced patient-directed discharge versus those who did not. The primary outcomes were 30 day, 90 day, and 2 year re-admission and mortality rates related to IE. The secondary outcome was worsened IE, which encompassed pertinent clinical and microbiologic outcomes. Results 391 patients were identified and included. Of these 47 (12%) experienced PDD and 344 (88%) did not. The PDD cohort was younger (mean age 33.3y (IQR 27.7 to 37.6) vs 60.1y (IQR 37.4 to 72.5 (p< 0.01)); more likely to be on Medicaid (75% vs 29% (p< 0.01)), undomiciled (17% vs 6.4% (p=0.01)), using intravenous drugs (87% vs 27% (p< 0.01)), and have psychiatric comorbidities (53% vs 33% (p< 0.01)). The PDD cohort received a mean of 17.3 days of IV antibiotics vs 36.5 days in the controls (p< 0.01) with 26 (55%) of the PDD cohort getting oral antibiotics upon discharge with an average duration of oral antibiotics of 29.3 days. Compliance on oral antibiotics was low in the PDD cohort (46%). There was no significant difference in death related to IE (0% vs 4% (p=0.3)). 30 and 90 day readmission rates were significantly higher in the PDD cohort (38% and 47% vs 11% and 15% (p< 0.01)). The PDD cohort was significantly more likely to be readmitted with new heart valves involved (21% vs 3% (p< 0.01)), new paravalvular abscess (9% vs 1% (p< 0.01)), different causative organisms (40% vs 18% (p< 0.01)), and/or new metastatic sites of infection. Conclusion Adult patients with IE who experience PDD are more likely to be younger, undomiciled, to use intravenous drugs and to have a psychiatric comorbidity. These patients have significantly worse outcomes from IE. Further treatment and outreach strategies in this patient population are essential to improve outcomes. Disclosures All Authors: No reported disclosures