Infective Endocarditis: New Challenges in a Classic Disease

Cuervo, Guillermo MD, PhD
Hernández-Meneses, Marta MD
Falces, Carles MD, PhD
Quintana, Eduard MD, PhD
Vidal, Bárbara MD, PhD
Marco, Francesc MD, PhD
Perissinotti, Andrés MD, PhD
Carratalà, Jordi MD, PhD
Miro, Jose M. MD, PhD

¹Infectious Diseases Service, Hospital Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
²Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
³Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
⁴Cardiology Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
⁵Cardiovascular Surgery Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
⁶Microbiology Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
⁷Department of Nuclear Medicine, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
⁸Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain

Address for correspondence Jose M. Miro, MD, PhD, Infectious Diseases Service, Hospital Clínic, Villarroel, 170. 08036 Barcelona, Spain (e-mail: [email protected]).

Conflict of Interest

None declared.

Issue Theme Life-Threatening Infections: Pulmonary and Systemic Infections; Guest Editors: Marin H. Kollef, MD, and Scott T. Micek, PharmD

^*See Appendix.

Seminars in Respiratory & Critical Care Medicine 43(1):p 150-172, February 2022. | DOI: 10.1055/s-0042-1742482

Abstract

Infective endocarditis is a relatively rare, but deadly infection, with an overall mortality of around 20% in most series. Clinical manifestations have evolved in response to significant epidemiological shifts in industrialized nations, with a move toward a nosocomial or health-care-related pattern, in older patients, with more episodes associated with prostheses and/or intravascular electronic devices and a predominance of staphylococcal and enterococcal etiology.

Diagnosis is often challenging and is based on the conjunction of clinical, microbiological, and imaging information, with notable progress in recent years in the accuracy of echocardiographic data, coupled with the recent emergence of other useful imaging techniques such as cardiac computed tomography (CT) and nuclear medicine tools, particularly¹⁸ F-fluorodeoxyglucose positron emission/CT.

The choice of an appropriate treatment for each specific case is complex, both in terms of the selection of the appropriate agent and doses and durations of therapy as well as the possibility of using combined bactericidal antibiotic regimens in the initial phase and finalizing treatment at home in patients with good evolution with outpatient oral or parenteral antimicrobial therapies programs. A relevant proportion of patients will also require valve surgery during the active phase of treatment, the timing of which is extremely difficult to define. For all the above, the management of infective endocarditis requires a close collaboration of multidisciplinary endocarditis teams.