Skip to main content

Advertisement

SpringerLink
Log in

Modern epidemiology, prophylaxis, and diagnosis and therapy for infective endocarditis

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Infective endocarditis (IE) is a rare disease. Although its incidence and bacteriology have remained relatively stable in outpatient populations without injection drug use, health care-associated infections, particularly with staphylococcus, are becoming more common. Large-scale prospective clinical trials are unavailable to guide strategies for preventing IE, timing surgical intervention, and avoiding complications. We continue to rely on new data from smaller series and large observational databases to track these changes and improve care of patients. At the present time, there are several controversies regarding best practices in IE. In this review, we address the following questions: What is the future of recommendations for antibiotic prophylaxis against IE? How should we best use echocardiography in diagnosis, management and follow up of IE patients? What are the most appropriate antibiotic regimens for different patients in the face of shifting microbiology and demographics? Lastly, how should patients be selected for early surgery to avoid the complications of these infections?

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Mylonakis E, Calderwood SB: Infective endocarditis in adults. N Engl J Med 2001, 345:1318–1330.

    Article  PubMed  CAS  Google Scholar 

  2. Moreillon P, Que YA: Infective endocarditis. Lancet 2004, 363:139–149.

    Article  PubMed  Google Scholar 

  3. Tleyjeh IM, Steckelberg JM, Murad HS, et al.: Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. JAMA 2005, 293:3022–3028.

    Article  PubMed  CAS  Google Scholar 

  4. Martin-Davila P, Fortun J, Navas E, et al.: Nosocomial endocarditis in a tertiary hospital: an increasing trend in native valve cases. Chest 2005, 128:772–779.

    Article  PubMed  Google Scholar 

  5. Frazee BW, Lynn J, Charlebois ED, et al.: High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 2005, 45:311–320.

    Article  PubMed  Google Scholar 

  6. Simor AE, Ofner-Agostini M, Bryce E: The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001, 165:21–26.

    PubMed  CAS  Google Scholar 

  7. Hogevik H, Olaison L, Andersson R, et al.: Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore) 1995, 74:324–339.

    Article  CAS  Google Scholar 

  8. Strom BL, Abrutyn E, Berlin JA, et al.: Risk factors for infective endocarditis: oral hygiene and nondental exposures. Circulation 2000, 102:2842–2848.

    PubMed  CAS  Google Scholar 

  9. Fernandez-Guerrero ML, Verdejo C, Azofra J, de Gorgolas M: Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. Clin Infect Dis 1995, 20:16–23.

    PubMed  CAS  Google Scholar 

  10. Fowler VG Jr, Miro JM, Hoen B, et al.: Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005, 293:3012–3021. This article presents a very large, international series of patients with definite IE and confirms the increasingly important role of S. aureus as an IE pathogen. It also reviews the contribution of healthcareassociated infections and prevalence of methicillin-resistant S. aureus stratified by region.

    Article  PubMed  CAS  Google Scholar 

  11. Raoult D, Casalta JP, Richet H, et al.: Contribution of systematic serological testing in the diagnosis of infective endocarditis. J Clin Microbiol 2005, 43:5238–5242.

    Article  PubMed  CAS  Google Scholar 

  12. Everett ED, Hirschmann JV: Transient bacteremia and endocarditis prophylaxis. Medicine (Baltimore) 1977, 56:61–77.

    Article  CAS  Google Scholar 

  13. Lockhart PB, Brennan MT, Fox PC, et al.: Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review. Clin Infect Dis 2002, 34:1621–1626.

    Article  PubMed  Google Scholar 

  14. Bonow RO, Bonow RO, Cheitlin MD, et al.: Task Force 3: valvular heart disease. J Am Coll Cardiol 2005, 45:1334–1340.

    Article  PubMed  Google Scholar 

  15. Weinstein MP, Murphy JR, Reller LB, Lichtenstein KA: The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. Rev Infect Dis 1983, 5:54–70.

    PubMed  CAS  Google Scholar 

  16. Towns ML, Reller LB: Diagnostic methods current best practices and guidelines for isolation of bacteria and fungi in infective endocarditis. Infect Dis Clin North Am 2002, 16:363–376, ix–x.

    Article  PubMed  Google Scholar 

  17. Das M, Badley AD, Cockerill FR, et al.: Infective endocarditis caused by HACEK microorganisms. Annu Rev Med 1997, 48:25–33.

    Article  PubMed  CAS  Google Scholar 

  18. Doern GV, Davaro R, George M, Campognone P: Lack of requirement for prolonged incubation of Septi-Chek blood culture bottles in patients with bacteremia due to fastidious bacteria. Diagn Microbiol Infect Dis 1996, 24:141–143.

    Article  PubMed  CAS  Google Scholar 

  19. Durack DT, Lukes AS, Bright DK New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994, 96:200–209.

    Article  PubMed  CAS  Google Scholar 

  20. Li JS, Sexton DJ, Mick N, et al.: Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000, 30:633–638.

    Article  PubMed  CAS  Google Scholar 

  21. Bayer AS, Bolger AF, Taubert KA, et al.: Diagnosis and management of infective endocarditis and its complications. Circulation 1998, 98:2936–2948.

    PubMed  CAS  Google Scholar 

  22. Frontera JA, Gradon JD: Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis 2000, 30:374–379.

    Article  PubMed  CAS  Google Scholar 

  23. Chirillo F, Pedrocco A, De Leo A, et al.: Impact of harmonic imaging on transthoracic echocardiographic identification of infective endocarditis and its complications. Heart 2005, 91:329–333.

    Article  PubMed  CAS  Google Scholar 

  24. Heidenreich PA, Masoudi FA, Maini B, et al.: Echocardiography in patients with suspected endocarditis: a cost-effectiveness analysis. Am J Med 1999, 107:198–208.

    Article  PubMed  CAS  Google Scholar 

  25. Rosen AB, Fowler VG Jr, Corey GR, et al.: Cost-effectiveness of transesophageal echocardiography to determine the duration of therapy for intravascular catheter-associated Staphylococcus aureus bacteremia. Ann Intern Med 1999, 130:810–820.

    PubMed  CAS  Google Scholar 

  26. El-Ahdab F, Benjamin DK Jr. Wang A, et al.: Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia. Am J Med 2005, 118:225–229.

    Article  PubMed  Google Scholar 

  27. Rohmann S, Erbel R, Darius H, et al.: Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size. J Am Soc Echocardiogr 1991, 4:465–474.

    PubMed  CAS  Google Scholar 

  28. Baddour LM, Wilson WR, Bayer AS, et al.: Infective endocarditis: diagnosis,antimicrobial therapy,and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology,Stroke,and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2005, 111:3167–3184. These comprehensive guidelines cover all aspects of IE management. Clinicians who provide care for patients with IE should be familiar with the recommendations, and consultants will want to review them carefully.

    Article  Google Scholar 

  29. Kuehnert MJ, Hill HA, Kupronis BA, et al.: Methicillinresistant-Staphylococcus aureus hospitalizations,United States. Emerg Infect Dis 2005, 11:868–872.

    PubMed  Google Scholar 

  30. Fridkin SK, Hageman JC, Morrison M, et al.: Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005, 352:1436–1444.

    Article  PubMed  CAS  Google Scholar 

  31. Miller LG, Perdreau-Remington F, Rieg G, et al.: Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005, 352:1445–1453.

    Article  PubMed  CAS  Google Scholar 

  32. Turnidge J: Pharmacodynamics and dosing of aminoglycosides. Infect Dis Clin North Am 2003, 17:503–528.

    Article  PubMed  Google Scholar 

  33. Thuny F, Disalvo G, Belliard O, et al.: Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005, 112:69–75.

    Article  PubMed  Google Scholar 

  34. Netzer RO, Altwegg SC, Zollinger E, et al.: Infective endocarditis: determinants of long term outcome. Heart 2002, 88:61–66.

    Article  PubMed  CAS  Google Scholar 

  35. Netzer RO, Zollinger E, Seiler C, Cerny A: Infective endocarditis: clinical spectrum,presentation and outcome. An analysis of 212 cases 1980–1995. Heart 2000, 84:25–30.

    Article  PubMed  CAS  Google Scholar 

  36. Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ: Impact of valve surgery on 6-month mortality in adults with complicated,left-sided native valve endocarditis: a propensity analysis. JAMA 2003, 290:3207–3214. This well-done study provides some of the most compelling evidence to date regarding indications for and impact of valve surgery in native valve IE.

    Article  PubMed  CAS  Google Scholar 

  37. Hasbun R, Vikram HR, Barakat LA, et al.: Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA 2003, 289:1933–1940.

    Article  PubMed  Google Scholar 

  38. Zamorano J, de Isla LP, Malangatana G, et al.: Infective endocarditis: mid-term prognosis in patients with good in-hospital outcome. J Heart Valve Dis 2005, 14:303–309.

    PubMed  Google Scholar 

  39. Mugge A, Daniel WG, Frank G, Lichtlen PR: Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol 1989, 14:631–638.

    Article  PubMed  CAS  Google Scholar 

  40. Sanfllippo AJ, Picard MH, Newell JB, et al.: Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol 1991, 18:1191–1199.

    Article  Google Scholar 

  41. Steckelberg JM, Murphy JG, Ballard D, et al.: Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991, 114:635–640.

    PubMed  CAS  Google Scholar 

  42. Rohmann S, Erbel R, Gorge G, et al.: Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J 1992, 13:446–452.

    PubMed  CAS  Google Scholar 

  43. Di Salvo G, Habib G, Pergola V, et al.: Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001, 37:1069–1076.

    Article  PubMed  CAS  Google Scholar 

  44. Steckelberg JM, Murphy JG, Ballard D, et al.: Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991, 114:635–640.

    PubMed  CAS  Google Scholar 

  45. Chan KL, Dumesnil JG, Cujec B, et al.: A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis. J Am Coll Cardiol 2003, 42:775–780.

    Article  PubMed  CAS  Google Scholar 

  46. Deklunder G, Lecroart JL, Conger JL, et al.: Effects of myocardial contractility on microemboli production by mechanical heart valves in a bovine model. Tex Heart Inst J 2000, 27:236–239.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology 5G1, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, 94110, San Francisco, CA, USA

    Ann F. Bolger MD

Authors
  1. Lisa G. Winston MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ann F. Bolger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann F. Bolger MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Winston, L.G., Bolger, A.F. Modern epidemiology, prophylaxis, and diagnosis and therapy for infective endocarditis. Curr Cardiol Rep 8, 102–108 (2006). https://doi.org/10.1007/s11886-006-0020-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-006-0020-3

Keywords

Search

Navigation