Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Abstract

Background— Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. Methods and Results— This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. Conclusions— Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

Treatment of native valve endocarditis due to coagulase negative staphylococci, complicated by a drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)

“…Linezolid is a bacteriostatic drug and is not included in the recommendations of IDSA as bactericidal drugs are required to sterilize the vegetations with high bacterial density. 6 However, the British Society for Antimicrobial Chemotherapy documents treatment of individual cases successfully with oral linezolid and recommends oral linezolid as oral bioavailability is close to that achieved with intravenous administration. 7 They do not however recommend it as monotherapy.…”

Spinal infections due to Eikenella corrodens: Case report and literature review

“…infections, according to the US guidelines [16], the therapy of choice is ceftriaxone or alternatively a fluoroquinolone. European guidelines for treatment of endocarditis [17] recommend ceftriaxone or the combination of ampicillin (if sensitive) and gentamycin, or, after consulting an infectious disease specialist, alternatively a fluoroquinolone.…”

Infective Endocarditis After Transcatheter Aortic Valve Replacement: The Worst That Can Happen

“…Guidelines1, 13, 14 recommend early surgery to be performed in complicated cases of IE, including those with congestive heart failure, perivalvular complications, and high risk of embolism. Unfortunately, these recommendations cannot be applied in all patients with TAVR‐IE because contraindications to surgery frequently exist in this high‐risk population.…”