Home antibiotic therapy shows lower mortality than hospital care for infective endocarditis

A systematic review and meta-analysis pooling five comparative studies covering 3,497 adults is the first in this literature to compare outpatient parenteral antibiotic therapy (OPAT) against a genuine inpatient comparator for infective endocarditis, rather than pooling single-arm OPAT data alone. OPAT was associated with lower all-cause mortality (relative risk 0.40, 95% confidence interval 0.18–0.90) and lower acute kidney injury (relative risk 0.71, 95% confidence interval 0.59–0.86) than hospital-based treatment, with no significant difference in readmission, relapse, valve replacement or other complications.

Meta-analysis Statistical heterogeneity on the mortality outcome was high (I²=87%), meaning selection bias in the underlying comparative studies — healthier or more stable patients being more likely to be selected for OPAT in the first place — cannot be ruled out. That caveat belongs alongside the headline mortality figure, not separated from it.

For OPAT services managing appropriately selected, stabilised patients with infective endocarditis, this meta-analysis directly strengthens the evidence base for outpatient management as a comparator to hospital-based treatment in this specific, high-stakes indication, while the caveat on selection bias means it should inform rather than replace individualised clinical judgement on patient selection.