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Management Considerations in Infective Endocarditis: A Review.

Publication ,  Journal Article
Wang, A; Gaca, JG; Chu, VH
Published in: JAMA
July 3, 2018

IMPORTANCE: Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the length of treatment in the setting of emerging, sometimes inconclusive clinical research findings. OBSERVATIONS: Community-associated infective endocarditis remains the predominant form of the disease; however, health care accounts for one-third of cases in high-income countries. As medical interventions are increasingly performed on older patients, the disease incidence from cardiac implanted electronic devices is also increasing. In addition, younger patients involved with intravenous drug use has increased in the past decade and with it the proportion of US hospitalization has increased to more than 10%. These epidemiological factors have led to Staphylococcus aureus being the most common cause in high-income countries, accounting for up to 40% of cases. The mainstays of diagnosis are still echocardiography and blood cultures. Adjunctive imaging such as cardiac computed tomographic and nuclear imaging can improve the sensitivity for diagnosis when echocardiography is not conclusive. Serological studies, histopathology, and polymerase chain reaction assays have distinct roles in the diagnosis of infective endocarditis when blood culture have tested negative with the highest yield obtained from serological studies. Increasing antibiotic resistance, particularly to S aureus, has led to a need for different antibiotic treatment options such as newer antibiotics and combination therapy regimens. Surgery can confer a survival benefit to patients with major complications; however, the decision to pursue surgery must balance the risks and benefits of operations in these frequently high-risk patients. CONCLUSIONS AND RELEVANCE: The epidemiology and management of infective endocarditis are continually changing. Guidelines provide specific recommendations about management; however, careful attention to individual patient characteristics, pathogen, and risk of sequela must be considered when making therapeutic decisions.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 3, 2018

Volume

320

Issue

1

Start / End Page

72 / 83

Location

United States

Related Subject Headings

  • Staphylococcus aureus
  • Staphylococcal Infections
  • Humans
  • Heart Valve Prosthesis
  • General & Internal Medicine
  • Endocarditis, Bacterial
  • Endocarditis
  • Echocardiography
  • Defibrillators, Implantable
  • Anti-Bacterial Agents
 

Citation

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Wang, A., Gaca, J. G., & Chu, V. H. (2018). Management Considerations in Infective Endocarditis: A Review. JAMA, 320(1), 72–83. https://doi.org/10.1001/jama.2018.7596
Wang, Andrew, Jeffrey G. Gaca, and Vivian H. Chu. “Management Considerations in Infective Endocarditis: A Review.JAMA 320, no. 1 (July 3, 2018): 72–83. https://doi.org/10.1001/jama.2018.7596.
Wang A, Gaca JG, Chu VH. Management Considerations in Infective Endocarditis: A Review. JAMA. 2018 Jul 3;320(1):72–83.
Wang, Andrew, et al. “Management Considerations in Infective Endocarditis: A Review.JAMA, vol. 320, no. 1, July 2018, pp. 72–83. Pubmed, doi:10.1001/jama.2018.7596.
Wang A, Gaca JG, Chu VH. Management Considerations in Infective Endocarditis: A Review. JAMA. 2018 Jul 3;320(1):72–83.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 3, 2018

Volume

320

Issue

1

Start / End Page

72 / 83

Location

United States

Related Subject Headings

  • Staphylococcus aureus
  • Staphylococcal Infections
  • Humans
  • Heart Valve Prosthesis
  • General & Internal Medicine
  • Endocarditis, Bacterial
  • Endocarditis
  • Echocardiography
  • Defibrillators, Implantable
  • Anti-Bacterial Agents