INFECTIVE ENDOCARDITIS

Diagnosis of endocarditis is usually based on clinical, microbiologic, and echocardiographic findings. Treatment involves antimicrobial therapy targeted to the identified organism. Surgical indications include heart failure, uncontrolled infection, and prevention of embolic events.

Link to NEJM Article

Key Clinical Points

INFECTIVE ENDOCARDITIS

	• Staphylococci and streptococci account for 80% of cases of infective endocarditis, with staphylococci currently the most common pathogens.
	• Cerebral complications are the most frequent and most severe extracardiac complications. Vegetations that are large, mobile, or in the mitral position and infective endocarditis due to Staphylococcus aureus are associated with an increased risk of symptomatic embolism.
	• Identifying the causative microorganism is central to diagnosis and appropriate treatment; two or three blood cultures should routinely be drawn before antibiotic therapy is initiated.
	• When infective endocarditis is suspected, echocardiography should be performed as soon as possible.
	• Indications for surgery include heart failure, uncontrolled infection, and prevention of embolic events.
	• Treatment should involve a multidisciplinary team with expertise in cardiology, cardiac surgery, and infectious disease.
	• Indications for antibiotic prophylaxis have been restricted to invasive dental procedures in patients with a prosthetic valve, a history of infective endocarditis, or unrepaired cyanotic congenital heart disease. Bruno Hoen, M.D., Ph.D., and Xavier Duval, M.D., Ph.D. N Engl J Med 2013; 368:1425-1433April 11, 2013DOI: 10.1056/NEJMcp1206782