Infective Endocarditis: Update on Epidemiology, Outcomes, and Management

Abstract

Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. Although transthoracic and transesophageal echocardiography are essential for diagnosis, additional testing (nuclear, computed tomographic, and magnetic resonance imaging) is helpful in selected patients. Early surgical management, even in high-risk patients, has a mortality benefit because eradication of infection with antibiotics alone is difficult and because valve destruction often results in hemodynamic compromise. As part of a broad differential diagnosis, clinicians should consider the diagnosis of endocarditis in patients with risk factors, even when the clinical presentation is nonspecific. Blood cultures and echocardiography are the first steps for diagnosis. Other imaging modalities can enhance diagnosis, particularly in patients with intracardiac devices or prosthetic material. Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition.

<p>Status Quo of Diagnostic Procedures and Treatment of Inpatients with Infective Endocarditis at the Department of General Medicine at a University Hospital in a Suburban City in Japan: A Single-Hospital-Based Retrospective Study</p>

“…The combination of 18 F-FDG positron emission tomography and computed tomographic imaging ( 18 F-FDG PET/CT) could be useful tools for making diagnoses in patients in whom the diagnosis was obscure, such as IE complicating a prosthetic valve or intracardiac device, or detection of embolic complications, metastatic infections, or underlying cancers. 13 However, the Japanese Health Insurance system reimburses the cost of 18 F-FDG PET/CT only when this procedure is performed to detect a primary lesion of metastatic cancer of unknown origin, which may explain why many patients did not undergo 18 F-FDG PET/CT in the present retrospective study.…”

Aquaporin Channels in the Heart—Physiology and Pathophysiology

“…AQP9 is expressed in valvular tissue of patients with infective endocarditis [57], and this expression is associated with the development of acute heart failure [159]. The exact diagnosis of infective endocarditis is often missed or only made late in the course of the disease [160], and therefore, it is suggested that AQP9 expression may be a potential prognostic marker in infective endocarditis [159].…”

Contemporary Outcomes of Pulmonary Valve Endocarditis: A 16-Year Single Centre Experience

“…Infective endocarditis (IE) is a highly morbid infection of the cardiac endothelium with an overall 20% mortality in the first 30 days [1,2]. In recent years, the epidemiology of IE has changed dramatically.…”

“…In recent years, the epidemiology of IE has changed dramatically. The average age of the patients, rates of health care acquired IE, and infections related to cardiac devices and valvular prostheses have significantly increased [1,2]. Additionally, conventional predisposing factors for IE such as rheumatic heart disease have been replaced by conditions such as degenerative valve disease, diabetes mellitus, intravenous drug use (IVDU) and congenital heart disease [3,4].…”