Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Endocarditis is an inflammation of the endocardium, the membrane lining the chambers of the heart and covering the cusps of the heart valves. Infective endocarditis (IE) refers to infection of the heart valves by microorganisms, primarily bacteria. Endocarditis is often referred to as either acute or subacute depending on the clinical presentation. Acute bacterial endocarditis is a fulminating infection associated with high fevers, systemic toxicity, and death within days to weeks if untreated. Subacute infectious endocarditis is a more indolent infection, usually occurring in a setting of prior valvular heart disease. +++ ETIOLOGY ++ Most patients with IE have risk factors, such as preexisting cardiac valve abnormalities. Many types of structural heart disease resulting in turbulence of blood flow will increase the risk for IE. Some of the most important risk factors include the following: ✔ Highest risk: presence of a prosthetic valve or previous IE ✔ Congenital heart disease (CHD), chronic intravenous (IV) access, diabetes mellitus, acquired valvular dysfunction (eg, rheumatic heart disease), cardiac implantable device, chronic heart failure, mitral valve prolapse with regurgitation, IV drug abuse (IVDA), HIV infection, and poor dentition and/or oral hygiene. Three groups of organisms cause most cases of IE: staphylococci, streptococci, and enterococci (Table 37-1). Staphylococci (S. aureus and coagulase-negative staphylococci) are the most common cause of prosthetic valve endocarditis (PVE) within the first year after valve surgery, and S. aureus is common in those with a history of IVDA. ++Table Graphic Jump LocationTABLE 37-1Etiologic Organisms in Infective EndocarditisaView Table|Favorite Table|Download (.pdf) TABLE 37-1 Etiologic Organisms in Infective Endocarditisa Agent Percentage of Cases Staphylococci 30–70 Coagulase positive S. aureus 20–68 Coagulase negative 3–26 Streptococci 9–38 Viridans streptococci 10–28 Other streptococci 3–14 Enterococci 5–18 Gram-negative aerobic bacilli 1.5–13 Fungi 1–9 Miscellaneous bacteria <5 Polymicrobial infections 1–2 Culture negative <5–17 aValues encompass community-acquired, healthcare-associated, native valve, and prosthetic valve infective endocarditis. +++ CLINICAL PRESENTATION ++ The clinical presentation of patients with IE is highly variable and nonspecific. Fever is the most common finding (more than 90% of patients). The mitral and aortic valves are most often affected. IE usually begins insidiously and worsens gradually. Patients may present with nonspecific findings such as fever, chills, weakness, dyspnea, cough, night sweats, weight loss, or malaise. Important clinical signs, especially prevalent in subacute illness, may include the following peripheral manifestations (“stigmata”) of endocarditis: Osler nodes, Janeway lesions, splinter hemorrhages, petechiae, clubbing of the fingers, Roth spots, and emboli. The patient may also have a heart murmur (sometimes new or changing), congestive heart failure, cardiac conduction abnormalities, cerebral manifestations, embolic phenomenon, and splenomegaly. Without appropriate antimicrobial therapy and surgery, IE is usually fatal. With proper management, recovery can be expected in most patients. Factors associated with increased mortality include: congestive heart failure, culture-negative endocarditis, endocarditis caused by resistant organisms such as fungi and ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options