Infective endocarditis--prophylaxis, diagnostic criteria, and treatment

Despite important medical advances, infective endocarditis (IE) is still a disease with high morbidity and mortality. Its prophylaxis, diagnosis, and treatment are still a major challenge in clinical practice.

Selective literature review based on the current German and European guidelines and a PubMed search from 2004 onward.

Essential requirements for the rapid diagnosis and specific treatment of IE are the echocardiographic demonstration of endocardial disease and the identification of the causative organism by blood culture. The modified Duke criteria have made the diagnosis more objective but are not a replacement for clinical judgement. It should be borne in mind, when the initial empirical treatment is chosen, that Staphylococcus aureus is currently the most common causative organism. If diagnostic criteria are met that suggest a methicillin-resistant S. aureus infection, then glycopeptide antibiotics are still the standard treatment. Newer agents such as daptomycin can be considered as an alternative, as suggested by recent studies and in view of the increasing frequency of impaired vancomycin susceptibility. Early surgical treatment should be considered for patients who are likely to encounter further complications along their clinical course. According to the current recommendations, antibiotics should be given for endocarditis prophylaxis only to patients about to undergo one of a small number of explicitly defined procedures, who would otherwise be at a high risk of major illness or death. The purpose of this restriction is to make prophylaxis more efficient.

IE remains a potentially lethal infectious disease that can be treated effectively only by physicians from multiple disciplines working in collaboration.