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Management of Endocarditis

  • Janek Manoj Senaratne
  • Sean van DiepenEmail author
Chapter

Abstract

Infective endocarditis most commonly affects patients with structural heart disease or select sociodemographic risk factors. The Modified Duke Criteria are recommended to establish a diagnosis of endocarditis. Medical treatment consists of early empiric broad spectrum antibiotics followed by therapy tailored to the individual organism’s sensitivity. Patients with complicated or medically refractory endocarditis may also require surgical intervention. This chapter focuses on the diagnosis, suggested antimicrobial therapy, and indications for emergent surgical intervention. Controversial aspects of management including timing of surgery, neuroimaging in infective endocarditis, and management of patients with cerebral embolic strokes are also reviewed.

Keywords

Infective endocarditis Modified Duke criteria Echocardiography Antimicrobial therapy Cardiac surgery Embolic stroke Endocarditis prophylaxis 

Supplementary material

Video 19.1

Parasternal long axis view of large aortic valve vegetation (AVI 23988 kb)

Video 19.2

Five chamber view with color doppler imaging showing severe aortic regurgitation (AVI 8852 kb)

References

  1. 1.
    Nishimura R, Otto C, Bonow R, Carabello B, Erwin III J, Guyton R, O’Gara P, Ruiz C, Skubas N, Sorajja P, Sundt T, Thomas J. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129:e521–643.CrossRefPubMedGoogle Scholar
  2. 2.
    Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Muller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009;30:2369–413.Google Scholar
  3. 3.
    Hoen B, Alla F, Selton-Suty C, Beguinot I, Bouvet A, Briancon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le Moing V, Leport C, Mainardi J, Ruimy R, Vandenesch F. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA. 2002;288:75–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Berlin J, Abrutyn E, Strom B, Kinman J, Levison M, Korzeniowski O, Feldoman R, Kaye D. Incidence of infective endocarditis in the Delaware Valley, 1988–1990. Am J Cardiol. 1995;76:933–6.CrossRefPubMedGoogle Scholar
  5. 5.
    van der Meer J, Thompson J, Valkenburg H, Michel M. Epidemiology of bacterial endocarditis in the Netherlands. 1. Patient characteristics. Arch Intern Med. 1992;152:1863–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Griffin MR, Wilson WR, Edwards WD, O’Fallon WM, Kurland LT. Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981. JAMA. 1985;254:1199–202.CrossRefPubMedGoogle Scholar
  7. 7.
    McKinsey DS, Ratts TE, Bisno AL. Underlying cardiac lesions in adults with infective endocarditis. The changing spectrum. Am J Med. 1987;82:681–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Grover FL, Cohen DJ, Oprian C, Henderson WG, Sethi G, Hammermeister KE. Determinants of the occurrence of and survival from prosthetic valve endocarditis. Experience of the Veterans Affairs Cooperative Study on Valvular Heart Disease. J Thorac Cardiovasc Surg. 1994;108:207–14.PubMedGoogle Scholar
  9. 9.
    Fernandez-Hidalgo N, Almirante B, Tornos P, Pigrau C, Sambola A, Igual A, Pahissa A. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis. 2008;47:1287–97.CrossRefPubMedGoogle Scholar
  10. 10.
    Hill EE, Herjgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J. 2007;28:196–203.CrossRefPubMedGoogle Scholar
  11. 11.
    Murdoch D, Corey G, Hoen B, Miro J, Fowler Jr V, Bayer A, Karchmer A, Olaison L, Pappas P, Moreillon P, Chambers S, Chu V, Falco V, Holland D, Jones P, Klein K, Raymond N, Read K, Tripodi M, Utili R, Wang A, Woods C, Cabell C. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2009;169:463–73.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Li JS, Sexton DJ, Mick N, Nettles R, Fowler Jr VG, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB. Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol. 1991;18:391–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Evangelista A, Gonzalez-Alujas M. Echocardiography in infective endocarditis. Heart. 2004;90:614–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Reynold HR, Jagen MA, Tunick PA, Kronzon I. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. J Am Soc Echocardiogr. 2003;16:67–70.CrossRefGoogle Scholar
  16. 16.
    Dodds G, Sexton D, Durack D, Bashore T, Corey G, Kisslo J. Negative predictive value of the Duke criteria for infective endocarditis. Am J Cardiol. 1996;15:403–7.CrossRefGoogle Scholar
  17. 17.
    Hoen B, Duval X. Clinical practice. Infective endocarditis. N Engl J Med. 2013;368:1425–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Vieira M, Grinberg M, Pomerantzeff P, Andrade J, Mansur A. Repeated echocardiographic examinations of patients with suspected infective endocarditis. Heart. 2004;90:1020–4.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kang D, Kim Y, Kim S, Sun BJ, Kim D, Yun S, Song J, Choo SJ, Chung C, Song J, Lee J, Sohn D. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med. 2012;366:2466–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Prendergast B, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010;121:1141–52.CrossRefPubMedGoogle Scholar
  21. 21.
    Ruttmann E, Willeit J, Ulmer H, Chevtchik O, Hofer D, Poewe W, Laufer G, Muller L. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke. 2006;37:2094–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Jovin T, Chamorro A, Cobo E, de Miquel M, Molina C, Rovira A, Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk A, von Kummer R, Gallofré M, Dávalos A; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015. doi: 10.1056/NEJMoa1503780.
  23. 23.
    Campbell B, Mitchell P, Kleinig T, Dewey H, Churilov L, Yassi N, Yan B, Dowling R, Parsons M, Oxley T, Wu T, Brooks M, Simpson M, Miteff F, Levi C, Krause M, Harrington T, Faulder K, Steinfort B, Priglinger M, Ang T, Scroop R, Barber P, McGuinness B, Wijeratne T, Phan T, Chong W, Chandra R, Bladin C, Badve M, Rice H, de Villiers L, Ma H, Desmond P, Donnan G, Davis S; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.Google Scholar
  24. 24.
    Duval X, Iung B, Klein I, Brochet E, Thabut G, Arnoult F, Lepage L, Laissy J, Wolff M, Leport C, IMAGE (Resonance Magnetic Imaging at the Acute Phase of Endocarditis) Study Group. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010;152:497–504.CrossRefPubMedGoogle Scholar
  25. 25.
    Chu V, Cabell C, Benjamin Jr D, Kuniholm E, Fowler Jr V, Engemann J, Sexton D, Corey G, Wang A. Early predictors of in-hospital death in infective endocarditis. Circulation. 2004;109:1745–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, Casabe JH, Chu VH, Delahaye F, Edathodu J, Fortes CQ, Olaison L, Pangercic A, Patel M, Rudez I, Tamin SS, Vincelk J, Bayer AS, Wang A. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis. 2013;56:209–17.CrossRefPubMedGoogle Scholar
  27. 27.
    Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan. J Thorac Cardiovasc Surg. 1995;110:1745–55.CrossRefPubMedGoogle Scholar
  28. 28.
    Zegdi R, Debieche M, Latremouille C, Lebied D, Chardigny C, Grinda JM, Chauvaud S, Deloche A, Carpentier A, Fabiani JN. Long-term results of mitral valve repair in active endocarditis. Circulation. 2005;111:2532–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Iung B, Rousseau-Paziaud J, Cormier B, Garbarz E, Fondard O, Brochet E, Acar C, Couetil JP, Hvass U, Vahanian A. Contemporary results of mitral valve repair for infective endocarditis. J Am Coll Cardiol. 2004;43:386–92.CrossRefPubMedGoogle Scholar
  30. 30.
    Delay D, Pellerin M, Carrier M, Marchand R, Auger P, Perrault LP, Hebert Y, Cartier R, Page P, Pelletier LC. Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis. Ann Thorac Surg. 2000;70:1219–23.CrossRefPubMedGoogle Scholar
  31. 31.
    Feringa H, Shaw L, Poldermans D, Hoeks S, van der Wall E, Dion R, Bax J. Mitral valve repair and replacement in endocarditis: a systematic review of literature. Ann Thorac Surg. 2007;83:564–70.CrossRefPubMedGoogle Scholar
  32. 32.
    Johansen J, Jørgensen O, Møller M, Arnsbo P, Mortensen P, Nielsen J. Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J. 2011;32:991–8.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Uslan D, Sohail M, St Sauver J, Friedman P, Hayes D, Stoner S, Wilson W, Steckelberg J, Baddour L. Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med. 2007;167:669–75.CrossRefPubMedGoogle Scholar
  34. 34.
    Sohail M, Uslan D, Khan A, Friedman P, Hayes D, Wilson W, Steckelberg J, Jenkins S, Baddour L. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc. 2008;83:46–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Critical Care MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Department of Critical Care Medicine, Division of CardiologyUniversity of AlbertaEdmontonCanada

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