Infective Endocarditis

Abstract

Background-Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results-This work represents the third iteration of an infective endocarditis "treatment" document 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 updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions-The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management. (Circulation. 2005; 111:e394-e433.)

Significance of the T2*-weighted gradient echo brain imaging in patients with infective endocarditis

“…Time interval from septic embolism to aneurysmal dilation can be as short as 24 hours [13]. Regardless of its high complication rate, at present, conventional CAG remains as gold standard in diagnosing intracranial IAs [1,12]. However, intracranial bleeding is not always secondary to rupture of IAs but often to other situations such as necrotic arteritis [14].…”

“…Significance of the T2*-weighted gradient echo brain imaging in patients with infective endocarditis Infective endocarditis (IE) is a disease accompanying considerable morbidity and mortality [1]. In patients with IE, central nerves system (CNS) involvement has been reported to develop in 20 to 40% [2,3].…”

“…In patients with IE, central nerves system (CNS) involvement has been reported to develop in 20 to 40% [2,3]. Infectious aneurysms (IAs), which are mostly small lesions in the intracranial arteries, manifest a variety of clinical presentations and have a mortality rate as high as 60% [1]. Although some IAs heal with only medical therapy even if they rupture, others may increase in size and number.…”

Native and Prosthetic Aortic Valve Endocarditis

“…In 1994, a diagnostic schema, termed the Duke criteria, was proposed. It stratified patients with suspected IE into 3 categories: "definite" cases, identified either clinically or pathologically (IE proved at surgery or autopsy); "possible" cases (not meeting the criteria for definite IE); and "rejected" cases (no pathological evidence of IE at autopsy or surgery, rapid resolution of the clinical syndrome with either no treatment or short-term antibiotic therapy, or a firm alternative diagnosis) (Durack et al, 1994;Baddour et al, 2005). The revised Duke Clinical Diagnostic Criteria for IE were published in 2000, and included the following changes: the category "possible IE" was defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria; the minor criterion "echocardiogram consistent with IE but not meeting major criterion" was eliminated, given the widespread use of transesophageal echocardiography (TEE); bacteremia because of S. aureus was considered a major criterion, regardless of whether the infection was nosocomially acquired or whether a removable source of infection was present; and positive Q-fever serology was changed to a major criterion (Li et al, 2000).…”

Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

“…Modern guidelines agree that IE per se is not an indication for anticoagulant therapy, but varying recommendations are given concerning ongoing anticoagulant therapy at the time of IE diagnosis [7][8][9]. Current guidelines are based on experiences from the early years of IE treatment, retrospective studies mainly involving patients with prosthetic valve endocarditis (PVE) [10][11][12], and the opinions of authorities in the field [5,6].…”