From the Guidelines
Endocarditis is a serious and potentially life-threatening infection of the inner lining of the heart chambers and valves, typically caused by bacteria entering the bloodstream and attaching to damaged heart tissue. This condition requires prompt and effective treatment to prevent complications and improve outcomes. According to the most recent and highest quality study 1, the epidemiology of infective endocarditis has become more complex, with changes in pathogen prevalence, particularly a more common staphylococcal origin, affecting outcomes.
Key Characteristics of Endocarditis
- Typically caused by bacteria entering the bloodstream and attaching to damaged heart tissue
- Can be caused by other microorganisms, such as fungi, in certain cases 1
- Often presents with symptoms such as fever, fatigue, and heart palpitations
- Can lead to serious complications, including heart failure, stroke, and kidney damage, if left untreated or not properly managed
Diagnosis and Treatment
- Diagnosis is typically made using blood cultures and imaging studies, such as echocardiography
- Treatment requires a prolonged course of intravenous antibiotics, usually for 4-6 weeks, tailored to the specific causative organism
- Common regimens include combinations of penicillins (such as penicillin G or ampicillin) with gentamicin for streptococcal infections, or vancomycin plus gentamicin for staphylococcal infections
- Surgery may be necessary in cases with severe valve damage, persistent infection despite antibiotics, large vegetations with embolic risk, or heart failure
Prevention and Management
- Prevention involves antibiotic prophylaxis before certain dental or invasive procedures for high-risk patients with prosthetic heart valves, previous endocarditis, or specific congenital heart conditions
- Management requires close monitoring and follow-up to prevent complications and improve outcomes
- According to the American Heart Association 1, infective endocarditis in adults requires a comprehensive approach to diagnosis, antimicrobial therapy, and management of complications.
From the Research
Definition of Endocarditis
- Endocarditis is a life-threatening disease with substantial morbidity and mortality, characterized by an infection of the endocardial surface of the heart 2.
- It is a microbial infection of the endocardial surface of the heart, which can be caused by various micro-organisms, including staphylococci, streptococci, enterococci, and Gram-negative bacilli 3.
Causes and Risk Factors
- Most cases of endocarditis involve infection with viridans streptococci, enterococci, coagulase-positive staphylococci, or coagulase-negative staphylococci 4.
- Certain procedures, such as oral, dental, respiratory tract, and oesophageal procedures, can increase the risk of developing endocarditis, particularly in individuals with pre-existing heart conditions 2.
Treatment and Management
- The treatment of endocarditis depends on the identity and antibiotic susceptibility of the infecting organism, the type of cardiac valve involved, and characteristics of the patient, such as drug allergies 4.
- Antibiotic regimens, such as penicillin, gentamicin, and vancomycin, are commonly used to treat endocarditis, with the specific regimen depending on the causative micro-organism and the patient's condition 2, 4, 5, 3.
- The optimal duration of antibacterial treatment is typically 4-6 weeks, depending on the type of endocarditis and the patient's response to treatment 3.