[Current treatment of endocarditis : Innovations and controversies]

Area of Science:

• Cardiology
• Infectious Diseases
• Internal Medicine

Background:

• Infective endocarditis (IE) remains a severe disease despite advances in diagnostics and treatment.
• Epidemiological shifts show staphylococci replacing streptococci as the primary cause, with increased incidence of nosocomial infections and risk factors like invasive procedures and intravenous drug abuse.
• Patients with IE are increasingly older and present with more comorbidities, necessitating updated management strategies.

Purpose of the Study:

• To provide an update and overview of current clinical practice in the diagnostics and pharmacotherapy of infective endocarditis in adults.
• To highlight special considerations in IE pharmacotherapy, including partial oral therapy and the role of aminoglycosides.
• To address the impact of bioprosthetic valves and implantable cardiac devices on antibiotic selection and treatment duration.

Main Methods:

• Review of current clinical practice guidelines and literature on infective endocarditis diagnostics and pharmacotherapy.
• Analysis of epidemiological trends and risk factors associated with IE.
• Focus on interdisciplinary treatment approaches and specific therapeutic strategies such as partial oral therapy and aminoglycoside use.

Main Results:

• Staphylococci are now the most common cause of IE, surpassing streptococci.
• The incidence of IE is rising, with affected patients being older and having more comorbidities.
• Treatment selection and duration are significantly influenced by the presence of bioprosthetic valves and cardiac devices.

Conclusions:

• Modern infective endocarditis management requires an interdisciplinary approach.
• Pharmacotherapy must be tailored to the specific pathogen, its sensitivity, and patient-specific factors like prosthetic material.
• Partial oral therapy and judicious use of aminoglycosides are key components of contemporary IE treatment regimens.