Semin Respir Crit Care Med 2022; 43(01): 150-172
DOI: 10.1055/s-0042-1742482
Review Article

Infective Endocarditis: New Challenges in a Classic Disease

Guillermo Cuervo
1   Infectious Diseases Service, Hospital Bellvitge – IDIBELL, University of Barcelona, Barcelona, Spain
2   Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
,
Marta Hernández-Meneses
2   Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
3   Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
,
Carles Falces
4   Cardiology Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
,
Eduard Quintana
5   Cardiovascular Surgery Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
,
Bárbara Vidal
4   Cardiology Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
,
Francesc Marco
6   Microbiology Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
,
Andrés Perissinotti
7   Department of Nuclear Medicine, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
8   Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
,
Jordi Carratalà
1   Infectious Diseases Service, Hospital Bellvitge – IDIBELL, University of Barcelona, Barcelona, Spain
2   Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
,
Jose M. Miro
2   Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
3   Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
,
The Hospital Clinic and the Hospital of Bellvitge Endocarditis Team Investigators › Author Affiliations
Funding J.M.M. received a personal 80:20 research grant from Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017 to 2021. This study was supported by CIBERINFEC (CB21/13/00009 and CB21/13/00094), Instituto de Salud Carlos III, Madrid, Spain.

Abstract

Infective endocarditis is a relatively rare, but deadly infection, with an overall mortality of around 20% in most series. Clinical manifestations have evolved in response to significant epidemiological shifts in industrialized nations, with a move toward a nosocomial or health-care-related pattern, in older patients, with more episodes associated with prostheses and/or intravascular electronic devices and a predominance of staphylococcal and enterococcal etiology.

Diagnosis is often challenging and is based on the conjunction of clinical, microbiological, and imaging information, with notable progress in recent years in the accuracy of echocardiographic data, coupled with the recent emergence of other useful imaging techniques such as cardiac computed tomography (CT) and nuclear medicine tools, particularly 18F-fluorodeoxyglucose positron emission/CT.

The choice of an appropriate treatment for each specific case is complex, both in terms of the selection of the appropriate agent and doses and durations of therapy as well as the possibility of using combined bactericidal antibiotic regimens in the initial phase and finalizing treatment at home in patients with good evolution with outpatient oral or parenteral antimicrobial therapies programs. A relevant proportion of patients will also require valve surgery during the active phase of treatment, the timing of which is extremely difficult to define. For all the above, the management of infective endocarditis requires a close collaboration of multidisciplinary endocarditis teams.

* See Appendix.


Financial disclosures

J.M.M. has received consulting honoraria and/or research grants from Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted work. Other authors, no conflicts.




Publication History

Article published online:
16 February 2022

© 2022. Thieme. All rights reserved.

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