Infective Endocarditis: New Challenges in a Classic Disease

Guillermo Cuervo; Marta Hernández-Meneses; Carles Falces; Eduard Quintana; Bárbara Vidal; Francesc Marco; Andrés Perissinotti; Jordi Carratalà; Jose M. Miro; The Hospital Clinic and the Hospital of Bellvitge Endocarditis Team Investigators

doi:10.1055/s-0042-1742482

Seminars in Respiratory and Critical Care Medicine, Table of Contents

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

Authors

Guillermo Cuervo

¹Infectious Diseases Service, Hospital Bellvitge – IDIBELL, University of Barcelona, Barcelona, Spain

²Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
Marta Hernández-Meneses

²Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain

³Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
Carles Falces

⁴Cardiology Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
Eduard Quintana

⁵Cardiovascular Surgery Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
Bárbara Vidal

⁴Cardiology Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
Francesc Marco

⁶Microbiology Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
Andrés Perissinotti

⁷Department of Nuclear Medicine, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain

⁸Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
Jordi Carratalà

¹Infectious Diseases Service, Hospital Bellvitge – IDIBELL, University of Barcelona, Barcelona, Spain

²Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
Jose M. Miro

²Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain

³Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain

The Hospital Clinic and the Hospital of Bellvitge Endocarditis Team Investigators

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.

Keywords

infective endocarditis - epidemiology - pathogenesis - diagnostic criteria - cardiac surgery - antimicrobial treatment - outpatient parenteral antibiotic therapy (OPAT) - antibiotic prophylaxis

Full Text

References

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