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Gram-negative endocarditis: disease presentation, diagnosis and treatment
Emilio Bouza1,2,3,4, Patricia Muñoz1,2,3,4, Almudena Burillo1,2,3
1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Current Opinion in Infectious Diseases
|October 20, 2021
Summary
Gram-negative bacilli infective endocarditis (IE) is increasing. Non-HACEK GNB-IE has higher mortality, requiring combination therapy and careful surgical consideration for better outcomes.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Gram-negative bacilli (GNB) cause 1-10% of infective endocarditis (IE).
- The HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) traditionally causes most GNB-IE.
- Non-HACEK GNB-IE is increasing and associated with higher mortality and specific risk factors.
Purpose of the Study:
- To review current knowledge on Gram-negative bacilli infective endocarditis (GNB-IE).
- To address uncertainties in medical and surgical treatment of GNB-IE.
- To discuss emerging therapies for multiresistant GNB-IE.
Main Methods:
- Literature review focusing on recent findings and clinical practice.
- Analysis of treatment strategies for HACEK and non-HACEK GNB-IE.
- Evaluation of indications for surgical intervention.
Main Results:
- Non-HACEK GNB-IE has a significantly higher mortality rate (20-30%) compared to HACEK-IE (2%).
- Treatment for HACEK IE has evolved; non-HACEK GNB-IE often requires combination therapy (beta-lactam with quinolone or aminoglycoside).
- Surgical intervention is crucial for many GNB-IE patients.
Conclusions:
- Management of GNB-IE requires a multidisciplinary approach with experienced teams.
- Treatment strategies must be tailored, especially for non-HACEK GNB-IE and multiresistant organisms.
- Ongoing research is needed for optimal therapeutic regimens and surgical timing.
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