Infective Endocarditis in the Elderly: Diagnostic and Treatment Options.

Area of Science:

• Cardiology
• Infectious Diseases
• Geriatrics

Background:

• Infective endocarditis (IE) is a serious condition with high mortality, increasingly affecting the elderly population.
• Peak incidence has shifted to age 70, with older adults having a five-fold higher risk.
• Elderly patients present with non-specific symptoms and comorbidities, complicating diagnosis and outcomes.

Purpose of the Study:

• To provide a comprehensive review of infective endocarditis (IE) in elderly patients.
• To address the unique diagnostic and therapeutic challenges in this demographic.
• To guide clinicians on management strategies, including antibiotic therapy and surgical considerations.

Main Methods:

• Review of clinical and microbiological diagnostic procedures for IE in the elderly.
• Analysis of epidemiological shifts in IE pathogens and resistance patterns in older adults.
• Discussion of treatment strategies, including antibiotic selection, prophylaxis, and surgical intervention.

Main Results:

• Elderly IE patients show higher rates of coagulase-negative staphylococci, enterococci, and Streptococcus bovis, with increased methicillin resistance.
• Diagnosis is challenging due to non-specific symptoms and comorbidities.
• Treatment is complicated by prolonged antibiotic needs and potential contraindications for surgery.

Conclusions:

• IE management in the elderly requires tailored approaches due to altered microbiology and increased comorbidities.
• Early and accurate diagnosis, alongside appropriate antibiotic selection and judicious surgical consideration, is crucial for improving outcomes.
• This review offers practical guidance for healthcare professionals managing infective endocarditis in older patients.