Key concepts

© For infective endocarditis (IE) to develop, the occurrence of several factors is required. These factors involve alterations to the endocardial surface which allow bacterial adherence and eventual infection.

©' Persistent fever is the most common symptom present in patients with IE.

Blood cultures are the essential laboratory test for the diagnosis and treatment of IE. Typically, patients with IE have a low-grade consistent bacteremia. Blood culture results are critical for determining the most appropriate therapy.

Echocardiograms are used for detecting the presence of a vegetation. Either a transthoracic echocardiogram (TTE) or a transesophageal echocardiogram (TEE) may be used depending on certain patient characteristics.

Choosing the appropriate antimicrobial therapy is crucial to achieve adequate organism kill.

® An extended treatment course of 4 to 6 weeks (in most cases) is required to achieve an adequate cure.

The overall goal of therapy is to eradicate the infection and minimize/prevent any complications.

® In an effort to prevent the development of IE, prophylactic treatment generally is considered appropriate for patients with high-risk factors.

O Monitoring the patient's clinical course is necessary to assess the effectiveness of therapy, detect the potential development of bacterial resistance, and determine outcome.

Infective endocarditis (IE) is a serious infection affecting the lining and valves of the heart. While this disease is mostly associated with infection of the heart valves, the septal defects may become involved as well. Infections also occur in patients with prosthetic or mechanical devices, such as mechanical heart valves or who are IV drug users (IVDUs). Bacteria is the primary cause of IE; however, fungi and atypical organisms may also be responsible pathogens.

Typically IE is classified into two categories: acute or subacute. The difference between the two categories is based on the progression and severity of the disease. Acute disease is more aggressive, characterized by high fevers, elevated WBC counts, and systemic toxicity, with death occurring within a few days to weeks. This type of IE is often caused by more virulent organisms, particularly Staphylococcus aureus. Subacute disease is typically caused by less virulent organisms, such as viridans streptococci, producing a slower and more subtle presentation. It is characterized by weakness, fatigue, low-grade fever, night sweats, weight loss, and other nonspecific symptoms, with death occurring in several months.

Successful management of patients with IE is based on proper diagnosis, treatment with adequate therapy, and monitoring for complications, adverse events, or development of resistance. The treatment and management of IE are best determined through identification of the causative organism. IE has varied clinical presentations; there fore, patients with this infection may be found in any medical subspecialty (i.e., medicine, surgery, critical care, etc.).

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