Definition Endocarditis is an inflammation of the endocardium, the membrane lining the chambers of the heart and covering the cusps of the heart valves. Infective endocarditis refers to infection of the heart valves by microorganisms. Endocarditis is often referred to as either acute or subacute depending on the clinical presentation. Acute bacterial endocarditis is a fulminating infection associated with high fevers, systemic toxicity, and death within a few days to weeks if untreated. Subacute infectious endocarditis is a more indolent infection, usually occurring in a setting of prior valvular heart disease. Pathophysiology Most patients with Infective endocarditis have risk factors, such as preexisting cardiac valve abnormalities. Most types of structural heart […]

Treatment of Endocarditis

General principles The most important approach to treatment of Infective endocarditis includes isolation of the infecting pathogen and determination of antimicrobial susceptibilities, followed by high-dose, bactericidal antibiotics for an extended period. For most patients 4 to 6 weeks of therapy are required. Specific recommendations for treating Infective endocarditis caused by the most common organisms are discussed in this chapter. β- Lactam antimicrobials, such as penicillin G, nafcillin, and ampicillin, remain the drugs of choice for streptococcal, staphylococcal, and enterococcal endocarditis, respectively. For some pathogens, such as enterococci, the use of synergistic antimicrobial combinations (including an aminoglycoside) is essential to obtain a bactericidal effect. Nonpharmacologic therapy Surgery is an important adjunct to […]

Evaluation of therapeutic outcomes

The evaluation of patients treated for Infective endocarditis includes assessment of signs and symptoms, blood cultures, microbiologic tests (e.g., minimum inhibitory concentration, minimum bactericidal concentration, or serum bactericidal titers), serum drug concentrations, and other tests to evaluate organ function. Persistence of fever may indicate ineffective antimicrobial therapy, emboli, infections of intravascular catheters, or a drug reaction. In some patients, low-grade fever may persist even with appropriate antimicrobial therapy. With effective therapy, blood cultures should be negative within a few days, although microbiological response to vancomycin may be unusually slower. TABLE. Treatment of Staphylococcal Endocarditis in the Presence of a Prosthetic Valve or Other Prosthetic Materiala Antibiotic Dosage and Route Duration (wks) […]