Endocarditis: epidemiology, diagnosis and treatment

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Infective endocarditis (IE) incidence is rising, with prognosis heavily dependent on accurate diagnosis and effective treatment.
• Challenges in IE management include culture-negative cases and the need for precise antimicrobial selection.

Purpose of the Study:

• To outline optimal diagnostic and therapeutic strategies for infective endocarditis.
• To highlight indications for surgical intervention and prognostic factors in IE patients.

Main Methods:

• Review of clinical examination, transesophageal echocardiography for diagnosis.
• Emphasis on microbiological techniques for culture-negative IE.
• Guidance on antimicrobial therapy selection, including minimal bactericidal concentrations (MBC).
• Discussion of drug monitoring for organ involvement and toxic therapies.
• Criteria for surgical intervention based on vegetation size, MBC, and embolic events.

Main Results:

• Transesophageal echocardiography is key for unconfirmed IE.
• Culture-negative IE necessitates specific microbiological approaches.
• Large vegetations (>10 mm) and high MBC (>2 µg/ml) indicate high thromboembolic risk and surgical need.
• Early surgery improves prognosis in complicated IE cases (e.g., heart failure, renal failure, persistent sepsis).

Conclusions:

• Optimal IE management involves timely diagnosis, appropriate antimicrobial therapy guided by sensitivity testing, and judicious use of surgery.
• Early surgical intervention is crucial for improving survival and reducing morbidity in complex IE cases.