eMedicine Specialties > Infectious Diseases > Cardiovascular and Intravascular Infections

Infective Endocarditis: Follow-up

Author: John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
Contributor Information and Disclosures

Updated: Aug 23, 2009

Follow-up

Further Inpatient Care

  • Patients should have blood cultures taken after 3-4 days of treatment to document eradication of the bacteremia.
    • Blood cultures during treatment are essential if persistent fever or other signs develop that suggest failing treatment.
    • Failure to sterilize the bloodstream, despite adequate serum levels of appropriate antibiotics, should prompt a search for metastatic infection (eg, abscesses, especially splenic, or mycotic aneurysm).
    • Fever lasting longer than 10 days into therapy with an indicated antibiotic regimen should be of concern and should prompt a search for suppurative complications. Approximately 30% of patients have a return of fever after the initial response. This is usually caused by an intracardiac abscess or metastatic infection. Causes of unresponsive fever include myocardial or septal abscesses, large vegetations that resist sterilization, and metastatic infection. Occasionally, fever in patients with uncomplicated infective endocarditis (IE) may take as long as 3 weeks to abate.
  • Relapse of IE usually occurs within 2 months of finishing clinically effective therapy.
    • Infection with S aureus, enterococci, and gram-negative organisms (especially P aeruginosa) is associated with a high rate of relapse.
    • Those with pretreatment symptoms of IE of more than 3 months' duration are at greater risk for relapse.
    • Enterococcal infection of the mitral valve has the greatest potential for relapse.
    • Recurrent IE occurs most often in individuals who abuse intravenous drugs. Valvular infections in these patients recur at a rate of 40%.
    • Other significant risk factors for recurrence include a previous episode of IE, the presence of a prosthetic valve, and congenital heart disease.
  • Monitor patients for the development of complications, including (1) valvular dysfunction, usually insufficiency of the mitral or aortic valves; (2) myocardial or septal abscesses; (3) congestive heart failure; (4) metastatic infection; (5) embolic phenomenon; and (6) organ dysfunction resulting from immunological processes. Note that the diagnosis of developing congestive heart failure or valvular insufficiency is based on clinical findings, not solely on echocardiographic measurements.
  • The onset of valve dysfunction or moderate-to-severe congestive heart failure should lead to an evaluation for immediate valve replacement.
  • Complications such as congestive heart failure resulting from valvular insufficiency and embolization may occur after bacteriologic cure has been achieved.
  • In general, infected vascular catheters should be removed and should not be replaced over a guidewire. Surgically implanted devices, such as Broviac or Hickman catheters, do not necessarily need to be removed unless evidence of IE, a tunnel infection, or suppurative thrombophlebitis is present or if the infecting organism is a Corynebacteria species, a Pseudomonas species, a fungus, S aureus, or a Mycobacterium species. If bacteremia persists longer than a few days, the catheter must be removed.55,56

Further Outpatient Care

  • Patients must be closely monitored for delayed development of congestive heart failure.

Inpatient & Outpatient Medications

  • Orally administered antibiotics have been used as suppressive therapy for incurable valvular infections (ie, inoperable prosthetic valve endocarditis [PVE]).

Transfer

  • Transfer the patient to a tertiary care cardiovascular center for surgical intervention in the following situations:
    • Significant congestive heart failure that develops in association with valve dysfunction
    • Conduction disturbances or echocardiogram findings that suggest the presence of a myocardial abscess
    • Recurrent emboli with vegetations larger than 1 cm in diameter remaining on the valve
    • Lack of response to antimicrobial therapy

Deterrence/Prevention

  • Approximately 15-25% of cases of IE are a consequence of invasive procedures that produce a significant bacteremia. Because only 50% of those who developed valvular infection following a procedure were identified as being candidates for antibiotic prophylaxis, only approximately 10% of cases of IE can be prevented by the administration of preprocedure antibiotics.
  • Maintaining good oral hygiene is probably more effective in the overall prevention of valvular infection because gingivitis is the most common source of spontaneous bacteremias.
  • The American Heart Association periodically compiles recommendations for IE prophylaxis. Updated guidelines (October 2007) are detailed here. Remembering that these are guidelines and not standards is important. They may be modified in particular circumstances. The guidelines remain unproven by randomized controlled clinical trials. Indeed, many examples of failure of these recommendations have been noted, even when they are applied appropriately.
    • The 3 major steps in the pathogenesis of IE that are vulnerable to antibiotic prophylaxis are (1) killing of the pathogen in the bloodstream before it can adhere to the valve, (2) preventing adherence to the valve/fibrin-platelet thrombus, and (3) eradicating any organisms that have attached to the thrombus.
    • Successful antibiotic prophylaxis requires (1) identifying those patients who are at risk, (2) prioritizing the procedures that require prophylaxis, and (3) selecting an appropriate antibiotic regimen. In general, bactericidal antibiotics are used. However, bacteristatic agents are probably effective in most circumstances.
    • Although the 2007 guidelines are a marked improvement because they prioritize the cardiac conditions and procedures that require antibiotic prophylaxis and emphasize the importance of promoting good oral hygiene, they offer little direction in dealing with the ever-growing problem of antibiotic-resistance patterns of S viridans and enterococci.
    • The importance of antibiotic prophylaxis of calcific valvular disease in elderly patients also needs to be more fully discussed. Calcific valvular disease is the most common underlying cardiac risk factor for the development of IE in this age group.
    • The author's preference is to administer parenteral prophylactic antibiotics to patients with prosthetic valves because of the severe consequences of PVE.
  • Prevention of vascular catheter infections is an important prophylactic approach in preventing nosocomial infective endocarditis (NIE). Protective factors include the insertion and maintenance of catheters by an infusion therapy team, the use of topical disinfectants and antibiotics, and the practice of coating catheters with antimicrobial agents.
  • No double-blind studies have been performed to support the use of systemically administered antibiotics for the prevention of pacemaker or intracardiac defibrillator infections. However, awaiting definitive studies, the authors recommend prophylactic antibiotics, as with any implantable device. Of course, strict sterile technique must be followed. Antibiotic prophylaxis is not recommended in patients with pacemakers or intracardiac defibrillators during other types of invasive procedures. Pacemaker infection due to transient bacteremias is uncommon.57

Complications

  • Monitor patients for the development of the following complications:
    • Valvular dysfunction, usually insufficiency of the mitral or aortic valves
    • Myocardial or septal abscesses
    • Congestive heart failure
    • Metastatic infection
    • Embolic phenomenon
    • Organ dysfunction resulting from immunological processes
  • Complications, such as congestive heart failure resulting from valvular insufficiency and embolization, may occur after bacteriologic cure has been achieved.

Prognosis

  • Cure rates for appropriately managed (including both medical and surgical therapies) native-valve endocarditis (NVE) are as follows:
    • For S viridans and S bovis infection, the rate is 98%.
    • For enterococci and S aureus infection in individuals who abuse intravenous drugs, the rate is 90%.
    • For community-acquired S aureus infection in individuals who do not abuse intravenous drugs, the rate is 60-70%.
    • For infection with aerobic gram-negative organisms, the rate is 40-60%.
    • For infection with fungal organisms, the rate is lower than 50%.
  • For PVE, the cure rates are as follows:
    • Rates are 10-15% lower for each of the above categories, for both early and late PVE.
    • Surgery is required far more frequently.
    • Approximately 60% of early CoNS PVE cases and 70% of late CoNS PVE cases are curable.
  • The fatality rate of pacemaker IE ranges up to 34%.58

Patient Education

  • Surveys indicate that an appallingly small number of patients who are at risk for developing IE have an understanding of antibiotic and nonpharmacologic (ie, appropriate oral hygiene) principles.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Tetralogy of Fallot.

Miscellaneous

Medicolegal Pitfalls

  • Infective endocarditis (IE) is a fatal disease, but effective therapy is available. Seek expert advice as needed.
  • As a rule for primary care clinics, do not administer antimicrobial agents to febrile patients with heart murmurs without first obtaining at least 2 sets of blood cultures.
  • Many malpractice suits are caused by a failure to diagnose and a delay in diagnosis accompanied by a poor outcome for the patient.
  • The perception that most IE is preventable is wrong. Frequent episodes of transient bacteremia occur with chewing and other activities of daily life. Proving that a failure to give prophylaxis before dental and surgical procedures resulted in IE is difficult. However, this does not prevent legal action alleging IE as a consequence of failing to give the antimicrobial prophylaxis recommended by the American Heart Association.
  • When a central venous line is needed, not inserting the line when a patient is known to be bacteremic is advisable. If no alternative to placing the line is available, bactericidal antimicrobial agents should be administered to try to prevent the development of IE.
 


More on Infective Endocarditis

Overview: Infective Endocarditis
Differential Diagnoses & Workup: Infective Endocarditis
Treatment & Medication: Infective Endocarditis
Follow-up: Infective Endocarditis
Multimedia: Infective Endocarditis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Lerner PI, Weinstein L. Infective endocarditis in the antibiotic era. N Engl J Med. Feb 17 1966;274(7):388-93 concl. [Medline].

  2. Lerner PI, Weinstein L. Infective endocarditis in the antibiotic era. N Engl J Med. Feb 3 1966;274(5):259-66 contd. [Medline].

  3. Lerner PI, Weinstein L. Infective endocarditis in the antibiotic era. N Engl J Med. Jan 27 1966;274(4):199-206 contd. [Medline].

  4. Brusch J. Infective Endocarditis: Management in the Era of Intravascular Devices. New York, NY: Informa Healthcare; 2007.

  5. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. Nov 1 2001;345(18):1318-30. [Medline].

  6. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. Mar 9 2009;169(5):463-73. [Medline].

  7. Miró JM, del Río A, Mestres CA. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin North Am. Jun 2002;16(2):273-95, vii-viii. [Medline].

  8. Baddour LM, Wilson LM. Infections of prosthetic valves and other cardiovascular devices: intravascular devices. In: Mandell GL, Bennett JE, Dolin R, eds. Mandel, Douglas and Bennett's Principles and Practice and Infectious Diseases. 5th ed. Philadelphia, Pa: Elsevier; 2005:1022-44.

  9. Weinstein LW, Brusch JL. Infective Endocarditis. New York, NY: Oxford University Press; 1996.

  10. Chu VH, Woods CW, Miro JM, Hoen B, Cabell CH, Pappas PA, et al. Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis. Clin Infect Dis. Jan 15 2008;46(2):232-42. [Medline].

  11. Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J. Jan 2007;28(2):196-203. [Medline].

  12. [Guideline] Towns ML, Reller LB. Diagnostic methods current best practices and guidelines for isolation of bacteria and fungi in infective endocarditis. Infect Dis Clin North Am. Jun 2002;16(2):363-76, ix-x. [Medline].

  13. Xiong YQ, Fowler VG, Yeaman MR, Perdreau-Remington F, Kreiswirth BN, Bayer AS. Phenotypic and genotypic characteristics of persistent methicillin-resistant Staphylococcus aureus bacteremia in vitro and in an experimental endocarditis model. J Infect Dis. Jan 15 2009;199(2):201-8. [Medline].

  14. Kradin RL. Pathology of infective endocarditis. In: Brusch JL, ed. Infective Endocarditis: Management in the Era of Intravascular Devices. New York, NY: Informa Healthcare; 2007:101-18.

  15. Brusch JL. Pathoanatomical, pathophysiological and clinical correlations. In: Brusch JL, ed. Infective Endocarditis: Management in the Era of Intravascular Devices. New York, NY: Informa Healthcare; 2007:119-41.

  16. Tleyjeh IM, Steckelberg JM, Murad HS, Anavekar NS, Ghomrawi HM, Mirzoyev Z, et al. Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. JAMA. Jun 22 2005;293(24):3022-8. [Medline].

  17. Crawford MH, Durack DT. Clinical presentation of infective endocarditis. Cardiol Clin. May 2003;21(2):159-66, v. [Medline].

  18. Di Salvo G, Habib G, Pergola V, Avierinos JF, Philip E, Casalta JP, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol. Mar 15 2001;37(4):1069-76. [Medline].

  19. Eknoyan G, Lister BJ, Kim HS, Greenberg SD. Renal complications of bacterial endocarditis. Am J Nephrol. 1985;5(6):457-69. [Medline].

  20. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine (Baltimore). Jul 1978;57(4):329-43. [Medline].

  21. [Guideline] Sexton DJ, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Cardiol Clin. May 2003;21(2):273-82, vii-viii. [Medline].

  22. Snygg-Martin U, Gustafsson L, Rosengren L, Alsiö A, Ackerholm P, Andersson R, et al. Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers. Clin Infect Dis. Jul 1 2008;47(1):23-30. [Medline].

  23. Terpenning MS, Buggy BP, Kauffman CA. Infective endocarditis: clinical features in young and elderly patients. Am J Med. Oct 1987;83(4):626-34. [Medline].

  24. Bansal RC. Infective endocarditis. Med Clin North Am. Sep 1995;79(5):1205-40. [Medline].

  25. Conlon PJ, Jefferies F, Krigman HR, Corey GR, Sexton DJ, Abramson MA. Predictors of prognosis and risk of acute renal failure in bacterial endocarditis. Clin Nephrol. Feb 1998;49(2):96-101. [Medline].

  26. Cosmi JE, Tunick PA, Kronzon I. Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr. Jul 2004;17(7):766-8. [Medline].

  27. Cunha BA, Gill MV, Lazar JM. Acute infective endocarditis. Diagnostic and therapeutic approach. Infect Dis Clin North Am. Dec 1996;10(4):811-34. [Medline].

  28. Fowler VG Jr, Scheld WM, Bayer AS. Endocarditis and intravascular infections. In: Mandell GL, Bennett JA, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Penn: Elseiver; 2005:975-1021.

  29. Roberts NK, Somerville J. Pathological significance of electrocardiographic changes in aortic valve endocarditis. Br Heart J. May 1969;31(3):395-6. [Medline].

  30. Robinson SL, Saxe JM, Lucas CE, Arbulu A, Ledgerwood AM, Lucas WF. Splenic abscess associated with endocarditis. Surgery. Oct 1992;112(4):781-6; discussion 786-7. [Medline].

  31. Weinstein L. Life-threatening complications of infective endocarditis and their management. Arch Intern Med. May 1986;146(5):953-7. [Medline].

  32. Weinstein L, Schlesinger JJ. Pathoanatomic, pathophysiologic and clinical correlations in endocarditis (first of two parts). N Engl J Med. Oct 17 1974;291(16):832-7. [Medline].

  33. Archibald LK, Pallangyo K, Kazembe P, Reller LB. Blood culture contamination in Tanzania, Malawi, and the United States: a microbiological tale of three cities. J Clin Microbiol. Dec 2006;44(12):4425-9. [Medline].

  34. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA. Jan 16 1991;265(3):365-9. [Medline].

  35. Khatib R, Riederer K, Saeed S, Johnson LB, Fakih MG, Sharma M, et al. Time to positivity in Staphylococcus aureus bacteremia: possible correlation with the source and outcome of infection. Clin Infect Dis. Sep 1 2005;41(5):594-8. [Medline].

  36. Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: how many blood cultures are needed?. J Clin Microbiol. Nov 2007;45(11):3546-8. [Medline].

  37. [Guideline] Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. Jul 1 2009;49(1):1-45. [Medline].

  38. Weinbaum FI, Lavie S, Danek M, Sixsmith D, Heinrich GF, Mills SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol. Mar 1997;35(3):563-5. [Medline].

  39. Weinstein MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol. Jun 2003;41(6):2275-8. [Medline].

  40. [Guideline] Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. Sep 2 2003;108(9):1146-62. [Medline].

  41. Jassal DS, Picard MH. Echocardiography. In: Brusch JL, ed. Infective Endocarditis: Management in the Era of Intravascular Devices. New York, NY: Informa Healthcare; 2007:255-72.

  42. Roe MT, Abramson MA, Li J, Heinle SK, Kisslo J, Corey GR, et al. Clinical information determines the impact of transesophageal echocardiography on the diagnosis of infective endocarditis by the duke criteria. Am Heart J. Jun 2000;139(6):945-51. [Medline].

  43. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. Mar 1994;96(3):200-9. [Medline].

  44. Fowler VG Jr, Li J, Corey GR, Boley J, Marr KA, Gopal AK, et al. Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol. Oct 1997;30(4):1072-8. [Medline].

  45. Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. Jun 22 2005;293(24):3012-21. [Medline].

  46. Khatib R, Johnson LB, Fakih MG, Riederer K, Khosrovaneh A, Shamse Tabriz M, et al. Persistence in Staphylococcus aureus bacteremia: incidence, characteristics of patients and outcome. Scand J Infect Dis. 2006;38(1):7-14. [Medline].

  47. Duval X, Selton-Suty C, Alla F, Salvador-Mazenq M, Bernard Y, Weber M, et al. Endocarditis in patients with a permanent pacemaker: a 1-year epidemiological survey on infective endocarditis due to valvular and/or pacemaker infection. Clin Infect Dis. Jul 1 2004;39(1):68-74. [Medline].

  48. [Guideline] Olaison L, Pettersson G. Current best practices and guidelines indications for surgical intervention in infective endocarditis. Infect Dis Clin North Am. Jun 2002;16(2):453-75, xi. [Medline].

  49. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. Jun 14 2005;111(23):e394-434. [Medline].

  50. Buckholz K, Larsen CT. Severity of gentamicin is nephrotoxic effect on patients with infective endocarditis: a prospective observation of cohort study of 373 patients. Clinical Infect Dis. 2009;48:65-71.

  51. Cunha BA. Persistent S. aureus acute bacteremia: clinical pathway for diagnosis and treatment. Antibiot for Clin. 2006;10:39-46.

  52. Falagas ME, Manta KG, Ntziora F, Vardakas KZ. Linezolid for the treatment of patients with endocarditis: a systematic review of the published evidence. J Antimicrob Chemother. Aug 2006;58(2):273-80. [Medline].

  53. Jones T, Yeaman MR, Sakoulas G, Yang SJ, Proctor RA, Sahl HG, et al. Failures in clinical treatment of Staphylococcus aureus Infection with daptomycin are associated with alterations in surface charge, membrane phospholipid asymmetry, and drug binding. Antimicrob Agents Chemother. Jan 2008;52(1):269-78. [Medline].

  54. Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC Jr, Eliopoulos GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol. Jun 2004;42(6):2398-402. [Medline].

  55. Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. Aug 2008;118(8):887-96.

  56. Netzer RO, Altwegg SC, Zollinger E, Täuber M, Carrel T, Seiler C. Infective endocarditis: determinants of long term outcome. Heart. Jul 2002;88(1):61-6. [Medline].

  57. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. Dec 28 2006;355(26):2725-32. [Medline].

  58. Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart. Jul 2002;88(1):53-60. [Medline].

  59. Brusch JL. Infective endocarditis and its mimics in the critical care unit. In: Cunha BA, ed. Infectious Diseases in Critical Care. 2nd ed. New York, NY: Informa Healthcare; 2007:261-2.

  60. Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. Jun 11 1997;277(22):1794-801. [Medline].

  61. Durack DT. Prevention of infective endocarditis. N Engl J Med. Jan 5 1995;332(1):38-44. [Medline].

  62. Eggiman P, Waldvogel FA. Pacemaker and defibrillator infections. In: Waldvogel FA, Bisno AL, eds. Infections Associated with Indwelling Medical Devices. Washington, DC: American Society for Microbiology; 2000:247-64.

  63. Oakley CM. The medical treatment of culture-negative infective endocarditis. Eur Heart J. Apr 1995;16 Suppl B:90-3. [Medline].

  64. Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. Jun 1 2002;34(11):1481-90. [Medline].

  65. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. Apr 1997;24(4):584-602. [Medline].

  66. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. Dec 6 1995;274(21):1706-13. [Medline].

[ CLOSE WINDOW ]

Keywords

infective endocarditis, IE, subacute bacterial endocarditis, acute bacterial endocarditis, fungal endocarditis, nosocomial infective endocarditis, NIE, intravenous drug abuse endocarditis, intravenous drug abuse infective endocarditis, IVDA endocarditis, IVDA IE, prosthetic valve endocarditis, PVE, pacemaker endocarditis, PM infective endocarditis, PM IE, endocardial infection, rheumatic heart disease, RHD, calcific aortic stenosis, congenital heart disease, ventricular septal defect, VSD, tetralogy of Fallot, Fallot tetralogy, mitral valve prolapse, MVP, native valve endocarditis, NVE, HACEK infection, bloodstream infection

Staphylococcus aureus, S aureus, Streptococcus viridans, S viridans, Streptococcus intermedius, S intermedius, Pseudomonas aeruginosa, P aeruginosa, Haemophilus aphrophilus, H aphrophilus, Actinobacillus actinomycetemcomitans, A actinomycetemcomitans, C hominis, Cardiobacterium hominis, Eikenella corrodens, E corrodens, Kingella kingae, K kingae, Candida albicans, C albicans, Candida parapsilosis, C parapsilosis, Candida tropicalis, C tropicalis, Bartonella quintana, B quintana,Coxiella burnetii

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Wesley W Emmons, MD, FACP, Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE
Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M Kerkering, MD, Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.