Infective Endocarditis Questions & Answers

Updated: Jan 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Questions & Answers

Overview

What is infective endocarditis (IE)?

What are classic signs of infective endocarditis (IE)?

What are the signs of neurologic disease in infective endocarditis (IE)?

What are symptoms of subacute native valve endocarditis (NVE)?

What is the role of the Duke diagnostic criteria in infective endocarditis (IE)?

What are the major blood culture diagnostic criteria for infective endocarditis (IE)?

What are the major echocardiographic diagnostic criteria for infective endocarditis (IE)?

What are the minor diagnostic criteria for infective endocarditis (IE)?

How many criteria must be met for a definitive diagnosis of infective endocarditis (IE)?

What is the initial treatment of infective endocarditis (IE)?

How is infective endocarditis (IE) defined?

When was infective endocarditis (IE) first identified and described?

What causes infective endocarditis (IE)?

Why is infective endocarditis (IE) difficult to treat?

How is infective endocarditis (IE) categorized?

What are the classic characterizations of infective endocarditis (IE)?

What is the difference between acute and subacute native valve endocarditis (NVE)?

What causes prosthetic valve endocarditis (PVE)?

What causes IV drug abuse (IVDA) infective endocarditis (IE)?

Where does infective endocarditis (IE) due to infections of implantable pacemakers occur?

What is nosocomial infective endocarditis (NIE)?

How have the clinical characteristics of infective endocarditis (IE) evolved?

What is the pathogenesis of infective endocarditis (IE)?

What is the role of bacterial clumping in the pathogenesis of subacute infective endocarditis (IE)?

How is a thrombus produced in acute infective endocarditis (IE)?

What is the role of the Venturi effect in the pathogenesis of infective endocarditis (IE)?

What determines bacteria and fibrin platelet thrombus location in the pathophysiology of infective endocarditis (IE)?

Where can nonbacterial thrombotic endocarditis form?

What are features of microorganisms that commonly produce infective endocarditis (IE)?

What is the pathogenesis of pacemaker infective endocarditis (IE)?

How does S aureus penetrate the keratinocyte layer in the pathogenesis of infective endocarditis (IE)?

Which procedures can cause bacteremia in the pathogenesis of infective endocarditis (IE)?

What is the role of intravascular catheter infection in the pathogenesis of infective endocarditis (IE)?

How do bacteria colonize the heart valves in the pathogenesis of infective endocarditis (IE)?

Which antibodies are increased in subacute endocarditis?

What is the microscopic appearance of acute bacterial endocarditis?

What are the underlying causes of native valve endocarditis (NVE)?

What are the causes of prosthetic valve endocarditis (PVE)?

What are the causes of IV drug abuse (IVDA) infective endocarditis (IE)?

What are the causes of nosocomial infective endocarditis (IE)?

Which patient groups are more likely to develop fungal endocarditis?

Which symptoms are associated with the different etiologic agents of infective endocarditis (IE)?

What are the risk factors for infective endocarditis (IE)?

What is the incidence of infective endocarditis (IE) in the US?

What is the prevalence of infective endocarditis (IE) among different age groups?

How does the prevalence of infective endocarditis (IE) vary between males and females or among races?

What is the mortality rate for infective endocarditis (IE)?

What are the cure rates for native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE)?

How effective are oral antibiotics in the treatment of infective endocarditis (IE)?

What is the role of early valvular surgery in reducing mortality from infective endocarditis (IE)?

How do mortality rates compare between native valve endocarditis (NVE) and prosthetic valve endocarditis?

Which factors affect the mortality rate of infective endocarditis (IE)?

What are the NICE guidelines for infective endocarditis (IE) patient education?

Presentation

What are the presenting symptoms of infective endocarditis (IE)?

Which history suggests subacute infective endocarditis (IE)?

What history suggests acute infective endocarditis (IE)?

How are acute infective endocarditis (IE) and subacute infective endocarditis (IE) differentiated?

What comorbid conditions may be the source of bacteremia in infective endocarditis (IE)?

What are the symptoms of early subacute native valve endocarditis (NVE)?

Which factors affect the rate of embolization in native valve endocarditis (NVE)?

What are the renal symptoms of infective endocarditis (IE)?

What causes lumbosacral back pain in subacute infective endocarditis (IE)?

What are the symptoms of bacteria-free infective endocarditis (IE)?

What are the symptoms of early acute infective endocarditis (IE)?

What are the symptoms and complications of IV-drug-abuse (IVDA) infective endocarditis (IE)?

What are the characteristics and complications of prosthetic valve endocarditis (PVE)?

What are the characteristics and complications of pacemaker infective endocarditis (IE)?

What are the characteristics and complications of nosocomial infective endocarditis (NIE)?

What are the classic signs of infective endocarditis (IE)?

What are the less common signs and symptoms of infective endocarditis (IE)?

Which physical findings suggest subacute infective endocarditis (IE)?

Which physical findings suggest acute infective endocarditis (IE)?

What are possible complications of infective endocarditis (IE)?

What are the most common complications of infective endocarditis (IE)?

Which factors increase the risk of complications from infective endocarditis (IE)?

What is the prevalence of embolization in infective endocarditis (IE)?

What are the possible complications of acute infective endocarditis (IE)?

How does age affect risk for complications of infective endocarditis (IE)?

DDX

What is the role of the Duke criteria in the diagnosis of infective endocarditis (IE)?

What are the major blood culture criteria for infective endocarditis (IE)?

What are the major echocardiographic criteria for infective endocarditis (IE)?

What are the minor criteria for infective endocarditis (IE)?

Which criteria need to be met in order to establish a definitive diagnosis of infective endocarditis (IE)?

What are the rejection criteria for the diagnosis of infective endocarditis (IE)?

Which other conditions should be considered in the workup of infective endocarditis (IE)?

What are the differential diagnoses for Infective Endocarditis?

Workup

What is the role of blood cultures in the diagnosis of infective endocarditis (IE)?

Why is infective endocarditis (IE) a diagnostic challenge?

How is continuous bacteremia identified in the workup of infective endocarditis (IE)?

What is the prevalence of infective endocarditis (IE) in patients with staphylococcal bacteremia or catheters?

Which baseline lab studies should be performed in the workup of infective endocarditis (IE)?

Which lab findings are characteristic of infective endocarditis (IE)?

What is the prevalence of false-negative and false-positive lab findings in infective endocarditis (IE)?

What does a positive blood culture indicate in the diagnosis of infective endocarditis (IE)?

What is the procedure for obtaining blood cultures in the workup of infective endocarditis (IE)?

How is a catheter infection associated with infective endocarditis (IE) diagnosed?

What causes culture-negative infective endocarditis (IE)?

How is infective endocarditis (IE) diagnosed when microorganisms are seen on ultrasonography but blood cultures are persistently negative?

Which pathogens cause culture-negative infective endocarditis (IE)?

What algorithm for negative blood cultures should be followed in the workup of infective endocarditis (IE)?

When should a diagnosis of fungal infective endocarditis (IE) be considered?

How is a diagnosis of pacemaker infective endocarditis (IE) confirmed?

What is the role of echocardiography in the diagnosis of infective endocarditis (IE)?

What are the AHA guidelines for use of TEE and TTE in the diagnosis of infective endocarditis (IE) associated with CIED infection?

What is the role of two-dimensional cardiac Doppler ultrasonography in the diagnosis of infective endocarditis (IE)?

What is the advantage of TTE in the workup of infective endocarditis (IE)?

When is Doppler ultrasonography indicated in the workup of infective endocarditis (IE)?

Which conditions are associated with valvular thrombi in infective endocarditis (IE)?

What is the sensitivity of TTE for identification of valvular lesions in infective endocarditis (IE)?

What is the role of TEE in the diagnosis of infective endocarditis (IE)?

When are TEE and TTE contraindicated in the workup of infective endocarditis (IE)?

Which findings on echocardiography are predictive of complications of infective endocarditis (IE)?

What are the indications for each echocardiography technique in the diagnosis of infective endocarditis (IE)?

What is the role of two-dimensional Doppler ultrasonography in the diagnosis of infective endocarditis (IE)?

What radiographic findings suggest complications of infective endocarditis (IE)?

Which studies may be helpful in the diagnosis of infective endocarditis (IE)?

Treatment

What are the major goals of therapy for infective endocarditis (IE)?

What is the emergency department (ED) treatment of infective endocarditis (IE)?

How should antibiotics be chosen for the treatment of infective endocarditis (IE)?

Why is eradicating bacteria from the fibrin-platelet thrombus difficult in infective endocarditis (IE)?

How and where should antibiotics be administered in the treatment of infective endocarditis (IE)?

What are the AHA treatment guidelines for native valve endocarditis (NVE)?

What are the AHA treatment guidelines for native valve endocarditis (NVE) caused by resistant streptococci?

What are the AHA treatment guidelines for infective endocarditis (IE) or prosthetic valve endocarditis (PVE) caused by nonresistant enterococci, resistant or nutritionally variant S viridans, or S bovis?

What are the treatment options for enterococcal prosthetic valve endocarditis (PVE)?

What is the treatment for native valve endocarditis (NVE) caused by methicillin-sensitive S aureus (MSSA)?

When is vancomycin contraindicated in the treatment of infective endocarditis (IE)?

What is the treatment for prosthetic valve endocarditis (PVE) caused by methicillin-sensitive S aureus?

What is the role of linezolid in the treatment of infective endocarditis (IE)?

When should daptomycin be used in treatment of infective endocarditis (IE)?

What is the treatment for HACEK microorganisms in infective endocarditis (IE)?

What is the treatment for culture-negative native valve endocarditis (NVE)?

What is the treatment for culture-negative prosthetic valve endocarditis (PVE)?

Which antibiotics are used in the treatment of less common pathogens in infective endocarditis (IE)?

Why is prosthetic valve endocarditis (PVE) difficult to treat?

What is the treatment for penicillin-sensitive S viridans prosthetic valve endocarditis (PVE)?

What is the treatment for enterococcal prosthetic valve endocarditis (PVE)?

What is the treatment for vancomycin-resistant enterococci (VRE) prosthetic valve endocarditis (PVE)?

How are patients with prosthetic valve endocarditis (PVE) monitored, and when is valve replacement surgery indicated?

What is the treatment for fungal endocarditis?

What is the treatment for IV drug abuse (IVDA) infective endocarditis (IE)?

What is the role of bactericidal tests in the management of infective endocarditis (IE)?

What is the traditional approach to treatment of S aureus bacteremia in infective endocarditis (IE)?

What is the treatment of S aureus bacteremia in infective endocarditis (IE)?

What is the role of anticoagulation in the treatment of infective endocarditis (IE)?

When is surgery indicated for the treatment of native valve endocarditis (NVE)?

When is surgery indicated for the treatment of prosthetic valve endocarditis (PVE)?

What is the role of surgery for treatment of metastatic infections in infective endocarditis (IE)?

When is surgery indicated for the treatment of pacemaker infective endocarditis (IE)?

What are the AHA guidelines for surgical intervention in the treatment of pacemaker infective endocarditis (IE)?

What are the NICE guidelines for prophylaxis against infective endocarditis (IE)?

What is the prevalence of infective endocarditis (IE) caused by bacteremia from invasive procedures?

When is prophylaxis against infective endocarditis (IE) indicated?

Are coronary artery stents a risk factor for infective endocarditis (IE)?

Which procedures increase the risk of infective endocarditis (IE), and when should prophylaxis be considered?

How can nosocomial infective endocarditis (NIE) be prevented?

When is antibiotic prophylaxis against pacemaker infective endocarditis (IE) indicated?

How does antibiotic prophylaxis prevent infective endocarditis (IE)?

How is successful antibiotic prophylaxis of infective endocarditis (IE) achieved?

What is a limitation of the AHA guidelines for antibiotic treatment of infective endocarditis (IE)?

What is the most common underlying cardiac risk factor for infective endocarditis (IE) in the elderly?

What are the treatment considerations and potential pitfalls for infective endocarditis?

What specialist consultations are indicated in the treatment of infective endocarditis (IE)?

What monitoring is indicated following treatment of bacteremia in infective endocarditis (IE)?

How should the development of complications of infective endocarditis (IE) be monitored?

How common is relapse of infective endocarditis (IE)?

Guidelines

What are the American Heart Association guidelines for the treatment of infective endocarditis (IE) in adults?

Medications

What treatment approach is most likely to be successful in infective endocarditis (IE)?

Which medications in the drug class Antibiotics are used in the treatment of Infective Endocarditis?