ID:IOTS - Infectious Disease Insight Of Two Specialists 12. Managing Infective Endocarditis
Nov 15, 2021
Discover the complexities of managing infective endocarditis as the hosts dive into surgical considerations and treatment innovations. They evaluate the challenges of treating prosthetic valve infections, emphasizing patient-specific factors. Explore diverse guidelines and the evolving role of daptomycin, including its dosing and combination therapies. The conversation also tackles the impact of research protocols on real-world clinical practices and compares the efficacy of oral versus intravenous antibiotics, showcasing personal treatment preferences.
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Key Prognostic Factors
- Older age, prosthetic valves, diabetes, frailty and immunosuppression predict worse endocarditis outcomes.
- Periannular complications, severe regurgitation, large vegetations and certain organisms (S. aureus, fungi, non-HACEK GN) also worsen prognosis.
When To Escalate To Surgery
- Push for urgent surgery when patients develop heart failure, uncontrolled infection, persistent positive blood cultures, or recurrent emboli.
- Use a multidisciplinary endocarditis team to weigh high surgical risk against potential benefits.
Why Endocarditis Needs Bactericidal, Long Therapy
- Vegetations have mixed-growth bacteria and high inoculum reduces antibiotic effectiveness (inoculum effect).
- Bactericidal drugs and prolonged therapy (≥2–6 weeks) are crucial to sterilize deep vegetation cores.