Advances in the Diagnosis and Treatment of Infective Endocarditis

Advances in the Diagnosis and Treatment of Infective Endocarditis

R. Brigg Turner (Pacific University School of Pharmacy, USA) and Jacqueline Schwartz (Pacific University School of Pharmacy, USA)
DOI: 10.4018/978-1-5225-2092-4.ch010
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Infective endocarditis is a relatively uncommon infectious disease that leads to substantial mortality and morbidity. This disease primarily involves bacterial infection of the heart valves. Diagnosis is contingent upon excellent physical examination and radiological and microbiological evidence. While failure to identify the causative microorganism does not preclude the diagnosis of infective endocarditis, management is more difficult. Recent advances have improved the etiological identification and allowed for shorter time to optimal antibiotic therapy. Advances in treatment have focused on therapies to combat drug-resistant microorganisms as well as mitigate adverse events. While new therapies are available, there exists a paucity of clinical evidence and further studies are required.
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Epidemiology And Pathophysiology

Two major guidelines have been published regarding the diagnosis and treatment of infective endocarditis; the United States (US) guideline was recently updated in 2015 (Baddour, 2015) as was the European Society of Cardiology guidelines (Habib, 2015). While infection of any part of the inner lining heart would be included in this syndrome, the heart valves have a higher probability of becoming infected (Fowler, 2015).

During the 20th century, the median age of patients with infective endocarditis has gradually increased from less than 30 years to the current estimated median of 50 years of age (Fowler, 2015; Murdoch, 2009). Of note, males more commonly become infected, particularly later in life. This has not always been the case but may be due to a number of factors including the decline in rheumatic fever, the aging population, and immunosenescence (Fowler, 2015).

Of alarming concern is the advent of healthcare-associated infective endocarditis. This new classification is likely due to increased incidence of surgical interventions, insertion of prosthetic material, and duration of indwelling catheters. This increase easily prompts anxiety in light of the rise of widespread antibiotic resistance and the proliferation of pandrug-resistant microorganisms (Spellberg, 2008; Spellberg 2013).

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