Infective Endocarditis

Last Reviewed Jan 2021. Last Modified Jan 2021.

Guidelines

• 2005 IDSA/AHA guidelines. Baddour et al. Circulation. 2005;111(23):e394-e434.
• 2015 IDSA/AHA guidelines. Baddour et al. Circulation.2015;132:1435-1486.
• European guidelines for the management of IE. Habib et al. Eur Heart J. 2015;36(44):3075-3128.
• European guidelines for echo in IE. Habib et al. Eur J Echocardiogr. 2010;11(2):202-219.

Review articles

• Microbiological diagnosis of IE. Washington. J Antimicrobial Chemother. 1987;20:29-36.
• Diagnostic criteria and problems in IE. Prendergast. Heart. 2004;90(6): 611–613.
• Infective Endocarditis. Hoen et al. N Engl J Med 2013;368:1425-1433.
• Management considerations in IE. Wang et al. JAMA. 2018;320(1):72-83.
• Fungal endocarditis. Ellis et al. Clin Infect Dis 2001;32:50-62.
• Fungal endocarditis. Pierrotti et al. Chest 2002;122:302-310.
• Aspergillus endocarditis. Kalokhe et al. Int J Infect Dis. 2010;14(12):e1040-e1047.
• Native-valve endocarditis. Chambers et al. N Engl J Med. 2020;383(6):567-576.
• IE in the ICU. Keynan et al. Crit Care Clin. 2013;29(4):923-51.
• Culture-negative and non-infective endocarditis. Katsouli et al. Ann Thorac Surg. 2013;95(4):1467-74.
• Culture negative endocarditis. Tattevin et al. Med Mal Infect. 2015;45(1-2):1-8.
• Combination therapy for IE. Goldstein et al. Clin Infect Dis. 2003;36(5):615-621.
• Noninfective endocarditis. Hurrell et al. Heart. 2020;106:1023-1029.
• Diagnostic value of imaging for IE. Gomes et al. Lancet Infect Dis. 2017;17(1):e1-e14.

Systematic Reviews / Meta-analyses

• MA: surgery for Candida endocarditis had same outcomes as medically treated. Steinbach et al. J Infect. 2005;51(3):230-247.
• Optimal timing for early surgery in infective endocarditis: a meta-analysis. Liang et al. Interact Cardiovasc Thorac Surg 2016;22:336-345.
• Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Anantha Narayanan et al. Heart 2016;102:950-957.

Trials

• Cardiac CT and TEE compared to intraoperative findings. Feuchtner et al. J Am Coll Card. 2009;53(5):436-444.
• Cardiac CT and TEE compared to intraoperative findings. Gahide et al. AJR Am J Roentgenol. 2010;194:574-578.
• Cardiac CT and TEE compared to intraoperative findings. Kim et al. Circ Cardiovasc Imaging. 2018;11(3):e006986.
• Cardiac CT and TEE compared to intraoperative findings. Koo et al. Eur Heart J Card Imaging 2018;19(2):199-207.
• Cardiac CT for perivalvular complications. Hryniewiecki et al. Eur Radiool. 2019;29(8):4368-4376.
• PET-CT for the diagnosis of IE. Saby et al. J Am Coll Cardiol. 2013;61(23):2374-2382.
• TEPvENDO: whole-body FDG-PET-CT for suspected IE. Duval et al. Clin Infect Dis. 2020;ciaa666
• POET trial: switch to PO. Iversen et al. N Engl J Med. 2019;380:415-424.
• 4 weeks of antibiotic is ok for native valve Enterococcal endocarditis, with caveats. Ramos-Martinez et al. PLoS One. 2020;15(8):e0237011.
• Long-term outcomes are poor in PWID with IE, even after surgery. Straw et al. Clin Infect Dis 2020;71(3):564-571.
• The risk of stroke in IE falls dramatically after initiation of antimicrobial therapy. stroke prevention is not a reason for valve surgery after 1 week. Dickerman et al. Am Heart J. 2007;154(6):1086-1094.
• Factors associated with embolic risk in IE: S. aureus and vegetation size markedly higher risk. scoring system for left-sided IE. Rizzi et al. BMC Infect Dis. 2014;14:230.
• Vegetation length by echo is a strong predictor of embolic events and mortality. Thuny et al. Circulation. 2005;112(1):69-75.
• Comprehensive diagnostic strategy for culture-negative IE identified 62% of organisms. Fournier et al. Clin Infect Dis. 2010;51(2):131-140.
• NPV of TTE was 97% when using a strict criteria for cardiac abnormalities and when the quality is adequate. Sivak et al. J Am Soc Echocardiogr. 2016;29(4):315-322.
• TEE is highly sensitive and specific for IE and significantly more sensitive than TTE. Shively et al. J Am Coll Cardiol. 1991;18(2):391-397.
• Higher-dose daptomycin for left-sided IE due to Staph or Enterococcal species. Carugati et al. Antimicrob Agents Chemother. 2013;57(12):6213-6222.
• Use of gentamicin combination for IE (case report). Murray et al. Arch Intern Med. 1976;136(4):480-483.
• Gentamicin for native valve IE due to Staph is nephrotoxic and shouldn’t be used. Cosgrove et al. Clin Infect Dis. 2009;48(6):713-721.
• Adding rifampin to vancomycin for MRSA IE didn’t improve outcomes. Levine et al. Ann Intern Med. 1991;115(9):674-680.
• Adding rifampin to treatment for SA native valve IE isn’t worth it due to hepatotoxicity and DDIs. Riedel et al. Antimicrob Agents Chemother. 2008;52(7):2463-2467.
• Higher MIC to vancomycin was associated with higher mortality for both MSSA IE and MRSA IE. Cervera et al. Clin Infect Dis. 2014;58(12):1668-1675.
• hVISA MRSA in IE was fairly common. Bae et al. J Infect Dis. 2009;200(9):1355-1366.
• Amp-ceftriaxone is as effective and less toxic than amp-gent for Enterococcal IE. Fernandez-Hidalgo et al. Clin Infect Dis. 2013;56(9):1261-1268.
• Amp-ceftriaxone is safe and effective in treating aminoglycoside-resistant Enterococcal IE. Gavalda et al. Ann Intern Med. 2007;146(8):574-579.
• Amp-ceftriaxone for Enterococcal IE. Pericas et al. Clin Microbiol Infect. 2014;20(12):O1075-O1083.
• PWID who undergo surgery for IE have 10x risk of death from 3-6 months from surgery compared to people who do not inject drugs. Shrestha et al. Ann Thorac Surg. 2015;100(3):875-882.
• PWID have a similar peri-operative mortality, but much lower longer-term survival compared to people who do not inject drugs. Rabkin et al. Ann Thorac Surg. 2012;93(1):51-57.
• PWID have a high peri-operative survival but lower long-term survival and high rate of reinfection. Osterdal et al. Interact Cardiovasc Thorac Surg. 2016;22(5):633-640.
• Toothbrushing associated with 23% rate of transient bacteremia with organisms that cause endocarditis; amoxicillin prophylaxis with tooth extraction significantly reduced the rate of transient bacteremia. Lockhart et al. Circulation. 2008;117(24):3118-3125.
• Cumulative effect of random bacteremias may be greater than from the occasional dental procedure. Roberts et al. Pediatr Cardiol. 1999;20(5):317-325.
• In-hospital mortality is 20% and 6-month mortality after IE is close to 30%. risk score to predict 6-month mortality; early surgery was associated with lower mortality. Park et al. J Am Heart Assoc. 2016;5(4):e003016.
• Prognostic factor for mortality in IE; early surgical intervention was associated with lower mortality. Netzer et al. Heart. 2002;88(1):61-66.
• Patients with higher operative risk have poorer long-term survival than those with lower operative risk. Chu et al. Circulation. 2015;131(2):131-140.
• Patients with IE have higher rates of all adverse cardiovascular events in the long term. Shih et al. Circulation. 2014;130(19):1684-1691.
• Improving the Diagnosis of Infective Endocarditis in Prosthetic Valves and Intracardiac Devices With 18F-Fluordeoxyglucose Positron Emission Tomography/Computed Tomography Angiography: Initial Results at an Infective Endocarditis Referral Center. Pizzi et al. Circulation. 2015 Sep 22;132(12):1113-26

Articles

• Infective endovascular fibrin sheath vegetations. Tang et al. Am J Med 2015;128(9):1029-1038.
• 3 clinical entities of IE. Halavaara et al. Open Forum Infect Dis. 2020;7(9):ofaa334.
• The changing epidemiology of IE in the 21st century. Ambrosioni et al. Curr Infect Dis Rep. 2018;19(5):21.
• Case report of successful treatment of VISA pacemaker lead infection with telavancin. Marcos et al. Antimicrob Agents Chemother. 2010;54(12):5376-5378.
• Duke criteria. Durack et al. Am J Med. 1994;96(3):200-209.
• Modified Duke criteria. Li et al. Clin Infect Dis. 2000;30(4):633-638.
• Trends in IE incidence, microbiology, and valve replacement in the US from 2000-2011. Pant et al. J Am Coll Cardiol. 2015;65(19):2070-2076.
• Editorial/Opinion. Beyond echo in IE; CT, 3D imaging, etc. Salaun et al. Circ Cardiovasc Imaging. 2018;11(3):e007626.
• Combination therapy for Enterococcal IE. Miro et al. Circulation. 2013;127(17):1763-1766.

Tweetorials

Why PWID get TVIE

1/
Why is tricuspid valve (TV) endocarditis more common in those who use intravenous drugs?

The portal of entry for most bacteria is the venous system. If quick access to the right-heart were enough, TV endocarditis would be more common in everyone.

There must be more to it… pic.twitter.com/YLXLE6wc4p

— Tony Breu (@tony_breu) September 19, 2018

Candida endocarditis

1/
Case conference will resume next week, so instead, let's dig into the archive for a learning case! Here is a case from @vdbPolly this past fall!

— BIDMC Infectious Diseases Fellowship (@BIDMC_IDFellows) July 15, 2020

Subacute endocarditis and immune complexes

It's the weekend, which means it is an excellent time to learn some #infectiousdiseases #IDboardreview:
A woman with a bioprosthetic valve p/w with a lower extremity rash x 4 months. Nephrotic range proteinuria and looking at the urine showed dymorphic RBCs. Rash as below: pic.twitter.com/1xzk6tjOok

— Yale ID Fellows (@YaleIDFellows) August 23, 2020

Advanced cardiac imaging for endocarditis

2/
Andrew did quick overview of imaging beyond TTE/TEE for endocarditis. The three options include
1⃣FDG PET CT
2⃣Cardiac CT
3⃣SPECT CT

Shout-out to another excellent #IDWeek2020 session (dx/management IE), moderated by our own Dr. Karchmer with Dr. Miro: https://t.co/oIUycgHz5z pic.twitter.com/ayiq60b8de

— BIDMC Infectious Diseases Fellowship (@BIDMC_IDFellows) November 11, 2020

Treatment of culture-negative endocarditis

1/
A few fun and quick pearls from today's Friday conference: culture neg endocarditis!#IDTwitter #IDMedEd #MedTwitter @ID_fellows

Q1:
Which of the following is the recommended tx and duration for Coxiella burnetii / Q fever endocarditis?

— BIDMC Infectious Diseases Fellowship (@BIDMC_IDFellows) October 9, 2020

Marantic endocarditis (ID Fellow case wrapup)

1/
Here's a wrap-up review tweetorial for reference + those who missed it on our last TWO #IDFellowCase (s)@npowah and @SAIRABT walked us through a case of 50F who p/w flank pain ➡️ found to have renal, splenic, and brain emboli on imaging ➡️final dx: marantic endocarditis pic.twitter.com/hfxlEyiWd6

— Infectious Disease Fellows Network (@ID_fellows) October 21, 2020

IE diagnosis in adults with congenital heart conditions:

Endocarditis diagnosis in adult congenital heart disease can be quite difficult, this article has very nice tables https://t.co/P4H7QLerCW pic.twitter.com/VoIEh7Tx0e

— Jonathan Ryder, MD (@JonathanRyderMD) May 17, 2021