Show Summary Details
Page of

Prevention and treatment of endocarditis 

Prevention and treatment of endocarditis
Chapter:
Prevention and treatment of endocarditis
Author(s):

Dominique Grisoli

and Didier Raoult

DOI:
10.1093/med/9780199600830.003.0161
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 30 November 2020

Initially always lethal, the prognosis of infective endocarditis (IE) has been revolutionized by antibacterial therapy and valve surgery. Nevertheless, it remains one of the deadliest infectious diseases, with ≥30% of patients dying within a year of diagnosis. Its incidence has also remained stable at 25–50 cases per million per year, and results predominantly from a combination of bacteraemia and a predisposing cardiac condition, including endocardial lesions and/or intracardiac foreign material. While antibiotic prophylaxis is recommended by various learned societies to cover healthcare procedures with the potential of causing bacteraemia in at-risk patients, there is no evidence to support this strategy. Even though the benefits are hypothetical, national guidelines should still be followed to avoid medico-legal issues. General preventive measures, such as education of clinicians and at-risk patients appear to be more crucial. Invasive procedures, especially intravenous catheterization, should be kept to the minimum possible. The severity of IE mandates a multidisciplinary and standardized approach to treatment, with involvement of dedicated surgeons within specialist centres. Standardized antibiotic protocols have produced dramatic reductions in hospital and 1-year mortality in reference centres. Most deaths now result from complications that constitute definite surgical indications, so optimization of surgical management and avoidance of delay will clearly improve prognosis. This disease has now entered an ‘early surgery’ era, with a more aggressive surgical approach showing promising results. Conditions such as septic shock, sudden death, and vancomycin-resistant staphylococcal endocarditis still constitute therapeutic and research challenges, and justify an important role for specialist centres.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.