Compliance with guidelines for antibiotic therapy in infective endocarditis in older adults: a national-based real life retrospective cohort study

Management of Infective Endocarditis (IE) is complex. This study aimed to describe compliance with the ESC 2015 guidelines of first-line antibiotic therapy in real life in older people. In this observational, longitudinal, retrospective, national-based, real-life cohort involving 34 French hospitals, we included patients aged 75 years or older, admitted with a diagnosis of possible or definite IE. In total, 929 patients were included (mean age of 83 ± 5 years; Mean Charlson comorbidity score of 3 ± 2) and 294 patients had at least one prosthetic valve. Left-sided IE was most frequent (76.2%), of which 42.8% involved the aortic valve. The most identified pathogens were Staphylococcus spp (42.2%) and Streptococcus spp (38.2%). In total, 43.9% patients had a first-line antibiotic regimen non-compliant with guidelines. By multivariable analysis, the factors independently associated with non-compliance to recommendations for first-line antibiotic treatment were BMI ≥ 25 kg/m 2 , IE located on a native valve (aortic or mitral), and the presence of suspected healthcare-associated IE. Compliance did not differ fundamentally according to the publication year of guidelines (ESC 2015 versus ESC 2023). In conclusion, despite the robustness of the procedures for producing practice guidelines, compliance is low, probably because there are no specific guidelines for older people.