Infective Endocarditis in the Elderly: Diagnostic and Treatment Options
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Infective endocarditis (IE) is an uncommon, life-threatening systemic disorder with significant morbidity and persistently high mortality. The age of the peak incidence of IE has shifted from 45 years in the 1950s to 70 years at the present time, and elderly people have a five-fold higher risk of IE than the general adult population. Elderly IE patients demonstrate a higher prevalence of coagulase-negative staphylococci, enterococci and Streptococcus bovis, and lower rates of infection by viridans group streptococci. Methicillin resistance is more prevalent in elderly patients as a consequence of increased nosocomial acquisition. The elderly are a vulnerable group in whom diagnosis is often difficult on account of non-specific presenting features and where higher prevalence of comorbidities contributes to adverse outcomes. Treatment of older patients with IE presents specific challenges associated with prolonged antibiotic therapy, and access to surgery may be denied on account of advanced age and attendant comorbidities. This practical review covers all aspects of elderly IE, including clinical and microbiological diagnosis and appropriate diagnostic procedures, initial antibiotic selection, antibiotic prophylaxis, considerations about antibiotic therapy and surgery.
Compliance with Ethical Standards
No funding was received for the preparation of this manuscript.
Conflict of interest
MPU, EDM, RR, JH, JBC and BP declare that they have no conflicts of interest relating to the content of this review.
- 7.Chu VH, Miro JM, Hoen B, on behalf of the International Collaboration on Endocarditis-Prospective Cohort Study Group, et al. Coagulase-negative staphylococcal prosthetic valve endocarditis: a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study. Heart. 2009;95:570–6.CrossRefGoogle Scholar
- 15.Olmos C, Vilacosta I, Fernández-Pérez C, Bernal JL, Ferrera C, García-Arribas D, Pérez-García CN, San Román JA, Maroto L, Macaya C, Elola FJ. The evolving nature of infective endocarditis in Spain: a population-based study (2003 to 2014). J Am Coll Cardiol. 2017;5(70):2795–804.CrossRefGoogle Scholar
- 16.Habib G, Lancellotti P, Antunes M, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.CrossRefGoogle Scholar
- 24.Sandoe JA, Barlow G, Chambers JB, et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother. 2015;70:325–59.CrossRefGoogle Scholar
- 31.Pizzi MN, Roque A, Fernández-Hidalgo N, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography: initial results at an infective endocarditis referral center. Circulation. 2015;132:1113–26.CrossRefGoogle Scholar
- 45.Olsen NT, DeBacker O, Thyregod HGH, et al. Prosthetic valve endocarditis after transcatheter aortic valve implantation. Circ Cardiovasc Interv. 2015;8:e001939. https://doi.org/10.1161/circinterventions.114.001939.CrossRefGoogle Scholar
- 51.Baddour LM, Epstein AE, Erickson CC, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Nursing, Council on Clinical Cardiology;, Interdisciplinary Council on Quality of Care and Outcomes Research, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121:458–77.CrossRefGoogle Scholar