Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis

Abstract

Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals’ experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction of new antimicrobials and novel combinations are exciting developments but also further complicate IE treatment choices. In this review, we provide and evaluate the relevant evidence focused around contemporary debates in IE treatment pharmacotherapy, including beta-lactam choice in MSSA IE, combination therapies (aminoglycosides, ceftaroline), the use of oral antimicrobials, the role of rifamycins, and long-acting lipoglycopeptides.

A Contemporary Review of the Use of Extracorporeal CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis

“…In patients with IE, bacteremia triggers complex interactions between microorganisms, platelets, diseased valvular endothelium, and host immunity, which contributes to vegetation and destruction of valvular or perivalvular tissue [2]. Accordingly, prolonged antibiotic therapy is mandatory for managing IE patients since valvular and perivalvular infections are difficult to control by host immunological responses and antibiotics [3]. Both the American Heart Association and European Society of Cardiology clinical guidelines have detailed the selection of an appropriate bactericidal treatment for IE patients in depth [4,5].…”

A Contemporary Review of the Use of Extracorporeal CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis

“…In patients with IE, bacteremia triggers complex interactions between the microorganism, platelets, diseased valvular endothelium and host immunity, which contributes to vegetations and destruction of valvular or perivalvular tissue [2]. Accordingly, prolonged antibiotic therapy is mandatory to manage IE patients since valvular and perivalvular infections are difficult to control by host immunological responses and antibiotics [3]. Both the American Heart Association and European Society of Cardiology clinical guidelines have detailed the selection of an appropriate bactericidal regimen for IE treatment in depth [4,5].…”

Correction: Adema et al. Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis. Pathogens 2023, 12, 703

“…There was an error in the original publication [ 1 ]. A typo in the twelfth sentence of the first paragraph of Section 2.3, “Cefazolin vs. ASPs”, was noted by the authors.…”