 |
|
Infective endocarditis: An old but changing disease
August 31, 2009Infective endocarditis (IE) is a severe form of valve disease characterized by infection located in the valves of the heart. It is still associated with a high mortality (10-26% in-hospital mortality). IE is a rare disease, with reported incidences ranging from 3 to 10 episodes/100,000 people per year.
Previous guidelines were published in 2004. Current revision was needed because of changes in the epidemiological profile, and significant advances in diagnostic and therapeutic strategies in these patients. The new guidelines will serve as a guide to help physicians to choose the best diagnostic and therapeutic strategy for their patients.
Two important points to underline:
1. A multidisciplinary approach is mandatory for the treatment of patients with infective endocarditis, including cardiologists, cardiac surgeons, and specialists of infectious diseases. They must be treated in highly specialized centers with surgical facilities. A recent work from our center showed that this multidisciplinary approach was responsible for a dramatic reduction in mortality in IE.
2. A second important conclusion of our study- reflected in the current guidelines- is that surgery must be performed much earlier than initially proposed, with good results. This point will be outlined by the current guidelines, which, for the first time, give information about optimal timing of surgery in patients with IE.
The main news in the current guidelines is:
a. Epidemiology of endocarditis is changing:
From an epidemiological point of view, IE has changed over the last few years, with newer predisposing factors - valve prostheses, degenerative valve sclerosis, intravenous drug abuse (IVDA), associated with the increased use of invasive procedures at risk for bacteremia, while rheumatic disease has nearly disappeared. Health care-associated IE (meaning IE caused by in-hospital contamination) represents up to 30% cases of IE, justifying aseptic measures during venous catheters manipulation and during any invasive procedures
b. Endocarditis prophylaxis is reduced: favor PREVENTION rather than PROPHYLAXIS
One of the main changes in the new ESC Guidelines is the proposed reduction of prophylaxis, because there is no real scientific proof of its efficacy, and it may be potentially dangerous. Thus, antibiotic prophylaxis is now recommended only for patients with the highest risk of IE undergoing the highest risk dental procedures (slide). Good oral hygiene and regular dental review have a very important role in reducing the risk of IE.
c. Echocardiography is the key of diagnosis, prognosis, and management of patients with endocarditis
Diagnosis of IE is frequently difficult, particularly in some subgroups (prosthetic valve IE [PVE], intracardiac device and blood-culture negative IE [BCNIE]). The key value of echocardiography is underlined (slide), as well as its value in predicting embolic events
d. Half patients with IE are operated on in Europe
The treatment of IE relies on the combination of prolonged antimicrobial therapy and - in about half patients - surgical eradication of the infected tissues. The 3 main complications of IE indicating early surgery are heart failure (HF), uncontrolled infection, and prevention of embolic events. The new guidelines will focus on these 3 main indications
e. Early surgery is safe and is recommended
One of the most controversial issues is the indication of surgery. It is very difficult to say in which case and at which time surgery must be performed. Particularly, the risk of embolism is very difficult to assess. The new guidelines will focus for the first time on the optimal timing of surgery.
European Society of Cardiology
1. A multidisciplinary approach is mandatory for the treatment of patients with infective endocarditis, including cardiologists, cardiac surgeons, and specialists of infectious diseases. They must be treated in highly specialized centers with surgical facilities. A recent work from our center showed that this multidisciplinary approach was responsible for a dramatic reduction in mortality in IE.
2. A second important conclusion of our study- reflected in the current guidelines- is that surgery must be performed much earlier than initially proposed, with good results. This point will be outlined by the current guidelines, which, for the first time, give information about optimal timing of surgery in patients with IE.
The main news in the current guidelines is:
a. Epidemiology of endocarditis is changing:
From an epidemiological point of view, IE has changed over the last few years, with newer predisposing factors - valve prostheses, degenerative valve sclerosis, intravenous drug abuse (IVDA), associated with the increased use of invasive procedures at risk for bacteremia, while rheumatic disease has nearly disappeared. Health care-associated IE (meaning IE caused by in-hospital contamination) represents up to 30% cases of IE, justifying aseptic measures during venous catheters manipulation and during any invasive procedures
b. Endocarditis prophylaxis is reduced: favor PREVENTION rather than PROPHYLAXIS
One of the main changes in the new ESC Guidelines is the proposed reduction of prophylaxis, because there is no real scientific proof of its efficacy, and it may be potentially dangerous. Thus, antibiotic prophylaxis is now recommended only for patients with the highest risk of IE undergoing the highest risk dental procedures (slide). Good oral hygiene and regular dental review have a very important role in reducing the risk of IE.
c. Echocardiography is the key of diagnosis, prognosis, and management of patients with endocarditis
Diagnosis of IE is frequently difficult, particularly in some subgroups (prosthetic valve IE [PVE], intracardiac device and blood-culture negative IE [BCNIE]). The key value of echocardiography is underlined (slide), as well as its value in predicting embolic events
d. Half patients with IE are operated on in Europe
The treatment of IE relies on the combination of prolonged antimicrobial therapy and - in about half patients - surgical eradication of the infected tissues. The 3 main complications of IE indicating early surgery are heart failure (HF), uncontrolled infection, and prevention of embolic events. The new guidelines will focus on these 3 main indications
e. Early surgery is safe and is recommended
One of the most controversial issues is the indication of surgery. It is very difficult to say in which case and at which time surgery must be performed. Particularly, the risk of embolism is very difficult to assess. The new guidelines will focus for the first time on the optimal timing of surgery.
European Society of Cardiology
Endocarditis Current Events and Endocarditis News RSSFew complications 1 year after aortic valve implantation
Research presented at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF), demonstrated an "exceptionally low" rate of complications one year after implantation of transcatheter aortic valve prostheses.
Artificial intelligence helps diagnose cardiac infections
Mayo Clinic researchers say that "teachable software" designed to mimic the human brain may help them diagnose cardiac infections without an invasive exam.
Scientists discover 21st century plague
Bacteria that can cause serious heart disease in humans are being spread by rat fleas, sparking concern that the infections could become a bigger problem in humans.
Infectious heart disease death rates rising again say scientists
Infectious heart disease is still a major killer in spite of improvements in health care, but the way the disease develops has changed so much since its discovery that nineteenth century doctors would not recognize it.
New step forward in search for solution to infection puzzle
Scientists at the University of York have helped to reveal more about the way bacteria can attach to human tissues.
Turning on cell-cell communication wipes out staph biofilms
University of Iowa researchers have succeeded in wiping out established biofilms of Staphylococcus aureus (staph) by hijacking one of the bacteria's own regulatory systems. Although the discovery is not ready for clinical application, the findings offer insight into a dispersal mechanism for staph biofilms and might help identify therapeutic targets.
Fewer heart patients need antibiotics before dental procedures
Based on a review of new and existing scientific evidence, most dental patients with heart disease do not need antibiotics before dental procedures to prevent infective endocarditis (IE), a rare, but life-threatening heart infection.
Most patients don't need antibiotics before dental procedures
Taking a precautionary antibiotic before a trip to the dentist isn¡¦t necessary for most people, and in fact, might create more harm than good, according to updated recommendations from the American Heart Association.
Scientists decode genome of oral pathogen
Virginia Commonwealth University researchers have decoded the genome of a bacteria normally present in the healthy human mouth that can cause a deadly heart infection if it enters the bloodstream.
Staph vaccine shows promise in mouse study
By combining four proteins of Staphylococcus aureus that individually generated the strongest immune response in mice, scientists have created a vaccine that significantly protects the animals from diverse strains of the bacterium that cause disease in humans.
More Endocarditis Current Events and Endocarditis News Articles
 |
Endocarditis: Diagnosis and Management by Kwan-Leung Chan (Editor), John M. Embil (Editor) "Endocarditis: Diagnosis and Management" provides an up-to-date approach to the diagnosis and management of endocarditis based on a critical analysis of the recent studies. The book is structured in a format that is easy to follow, clinically relevant and evidence based. |
 |
Color Atlas of Infective Endocarditis by David R. Ramsdale (Author) Infective endocarditis is a condition that still carries a high morbidity and mortality rate (20-30%) despite modern antibiotics and surgical treatment. The infection, usually caused by bacteria, invades the innermost lining of the heart and can damage heart valves, connective tissue and the heart chambers themselves. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome. If untreated, mortality is extremely high. The prevalence of infective endocarditis is between 1.7 and 4 people per 100,000, and is most commonly found in people who have underlying heart disease. Symptoms can be as non-specific as fever, fatigue, weight loss, new rashes (either painful or painless), headaches, backaches, joint pains and confusion; hence the... |
 |
An Atlas of Infective Endocarditis: Diagnosis and Management (Encyclopedia of Visual Medicine Series) by C. Ward (Author) This atlas contains more than 90 high-resolution color photographs, an introductory review, and a comprehensive bibliography on infective endocarditis, which remains a fatal disease in 20% - 30% of cases, is increasingly resistant to the penicillins, and, with the introduction of valve replacement surgery, can now appear as prosthetic valve endocarditis. The book has special value for residents in training, for primary-care physicians whose early diagnosis can be vital, and for cardiologists and cardiovascular surgeons. Coverage includes the pathogenesis and diagnosis of infective endocarditis, symptoms and clinical manifestations, methods of investigation, problem cases, and clinical management. |
 |
Endocarditis Medical Guide by Qontro Medical Guides (Author) The Endocarditis Medical Guide is a publication which has been designed to better help readers understand Endocarditis. This Qontro Medical Guide has been designed with the reader in mind, and is a useful information source for readers at all levels looking to learn more about Endocarditis. The Endocarditis Medical Guide is highly recommended for those interested in understanding and learning more about Endocarditis. |
 |
Infective Endocarditis: Management in the Era of Intravascular Devices (Infectious Disease and Therapy) by John L. Brusch (Author) The first up-to-date source on the subject in more than a decade, this authoritative and all-encompassing guide summarizes the latest findings on the epidemiology, pathogenesis, pathophysiology, clinical manifestations, diagnosis, and treatment of infective endocarditis. Written by a world recognized expert with more than 40 years of experience in the field, this reference focuses on the impact of staphylococci as causative organisms and their relationship to a variety of intravascular devices ranging from intravenous catheters to intracardiac defibrillators. |
|
Infective endocarditis (Clinical cardiology monographs) by Grune & Stratton (Publisher) | |
|
Subacute Bacterial Endocarditis by Emanuel & Charles Friedberg Libman (Author) | |
|
Not a screening tool: TEE overused in diagnosis of endocarditis.(Transesophageal echocardiography): An article from: Internal Medicine News by Mitchel L. Zoler (Author) This digital document is an article from Internal Medicine News, published by International Medical News Group on April 1, 2004. The length of the article is 431 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: Not a screening tool: TEE overused in diagnosis of endocarditis.(Transesophageal echocardiography) Author: Mitchel L. Zoler Publication: Internal Medicine News (Magazine/Journal) Date: April 1, 2004 Publisher: International Medical News Group Volume: 37 Issue: 7 Page: 50(1) Distributed by Thomson... | |
|
Endocarditis Prophylaxis by Cards Specialty (Author) | |
|
Infective Endocarditis and Other Intravascular Infections (Critical Issues in Psychiatry) by Lawrence Freedman (Author) |
| © 2009 BrightSurf.com |