Endocarditis in the intensive care unit: an update

Abstract

Purpose of reviewThe incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature.Recent findings IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory state and many also have several indwelling catheters, which favors infection. Increased performance and recent advances in cardiac imaging allow for easier diagnosis of EI, but the applicability of these techniques to ICU patients is still relatively limited. New developments in antibiotic treatment and adjunctive therapies are explored further in this review.

Endocarditis in critically ill patients: a review

“…Rational for prompt antibiotic initiation and blood cultures sampled before first antibiotic dosis is the same for septic patients. In patients with septic shock, urgent introduction of empirical antibiotics is recommended, and this recommendation should therefore also apply to patients with known or suspected IE and septic shock [60,61]. It is crucial to give appropriate antibiotic therapy empirically.…”

“…Most IE management recommendations are supported by low quality evidence from observational studies and expert opinion [32,38]. This issue was recently revised in this Journal [60] and no new breakthrough evidence was published since then. Table 2 summarizes the antimicrobial options suggested by most recently published guidelines.…”

“…The antibiotic regimens suggested in international guidelines (adapted from reference[60])Ceftriaxone 2 g/day for 4 weeks in NVE and for 6 weeks in PVE. If they do not produce beta-lactamase, ampicillin (12 g/day i.v.…”

Unsolved Controversies in Management of Infective Endocarditis

“…The clinical picture of IE can vary widely between patients (subacute, acute, or chronic), with presentation depending on the causative agent and patient-specific risk factors [ 2 ]. The pathogenesis of IE is widely attributed to a multi-hit theory implicating endothelial dysfunction and bacteremia as precursors [ 3 ]. In our case report, we will present the case of a 19-year-old previously healthy patient who was found to have IE, highlighting the nuances in the management of IE as tailored to our patient.…”

The impact of concomitant infective endocarditis in patients with spondylodiscitis and isolated spinal epidural empyema and the diagnostic accuracy of the modified duke criteria

“…Maintaining TTE as the first imaging examination should therefore always be considered depending on the clinical situation mentioned above, and TEE examination should then follow immediately regardless of the TTE findings due to the high prevalence of IE in SD ( 15 ). Cardiac computer tomography (CT) and 18F-FDG PET/CT represent additional options in the diagnostic algorithm ( 8 , 15 , 16 ).…”