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  • Image not available. Infective endocarditis is an uncommon infection usually occurring in persons with preexisting cardiac valvular abnormalities (e.g., prosthetic heart valves) or with other specific risk factors (e.g., intravenous drug abuse).
  • Image not available. Three groups of organisms cause a majority of infective endocarditis cases: streptococci, staphylococci, and enterococci.
  • Image not available. The clinical presentation of infective endocarditis is highly variable and nonspecific, although a fever and murmur usually are present. Classic peripheral manifestations (e.g., Osler nodes) may or may not occur.
  • Image not available. The diagnosis of infective endocarditis requires the integration of clinical, laboratory, and echocardiographic findings. The two major diagnostic criteria are bacteremia and echocardiographic changes (e.g., valvular vegetation).
  • Image not available. Treatment of infective endocarditis involves isolation of the infecting pathogen and determination of antimicrobial susceptibilities, followed by high-dose, parenteral, bactericidal antibiotics for an extended period.
  • Image not available. Surgical replacement of the infected heart valve is an important adjunct to endocarditis treatment in certain situations (e.g., patients with acute heart failure).
  • Image not available. β-Lactam antibiotics, such as penicillin G (or ceftriaxone), nafcillin, and ampicillin, remain the drugs of choice for streptococcal, staphylococcal, and enterococcal endocarditis, respectively.
  • Image not available. Aminoglycoside antibiotics are essential to obtain a synergistic bactericidal effect in the treatment of enterococcal endocarditis. Adjunctive aminoglycosides also may decrease the emergence of resistant organisms (e.g., prosthetic valve endocarditis caused by coagulase-negative staphylococci) and hasten the pace of clinical and microbiologic response (e.g., some streptococcal and staphylococcal infections).
  • Image not available.Vancomycin is reserved for patients with immediate β-lactam allergies and the treatment of resistant organisms.
  • Image not available. Antimicrobial prophylaxis is used as an attempt to prevent infective endocarditis for patients who are at the highest risk (such as persons with prosthetic heart valves) before a bacteremia-causing procedure (e.g., dental extraction).

On completion of the chapter, the reader will be able to:

  • 1. List patient populations at increased risk for developing infective endocarditis (IE).
  • 2. Delineate bacteria that commonly cause IE as well as situations where certain bacteria are more likely.
  • 3. Describe the sequential steps necessary to develop hematogenous spread of IE.
  • 4. Identify the clinical manifestations of the disease, including physical findings, laboratory abnormalities, blood cultures, and other diagnostic test (e.g., echocardiography).
  • 5. Argue the importance of correctly obtained blood cultures and state situations that may lead to "culture negative" IE.
  • 6. Justify the rationale for high-dose parenteral, bactericidal, extended duration antibiotics for IE treatment.
  • 7. Recognize the role of nonpharmacologic approaches (i.e., surgery) in the treatment of IE and identify situations where this approach is preferred.
  • 8. Design drug regimens for the following types of infective endocarditis: streptococci, staphylococci, enterococci, the HACEK microorganisms, and "culture negative" IE.
  • 9. Characterize why beta-lactam antibiotics are preferred for the treatment of IE and classify situations where vancomycin is appropriate.
  • 10. Judge the role of penicillin skin tests in patients with a documented penicillin allergy.
  • 11. Distinguish situations where aminoglycosides (i.e., gentamicin) should and should not be used for the treatment of IE and develop an appropriate dosing strategy based on the identified organism.
  • 12. Summarize approaches that can be used to ensure cost-effective ...

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