Infective endocarditis
Infective endocarditis (IE) is a subacute or acute infection of a native heart valve, prosthetic valve (e.g., mechanical, bioprosthetic, homograft, autograft), cardiac implantable electronic device (CIED) (e.g., pacemakers, implantable defibrillators, ventricular assist devices), or any structure within the heart, including normal endothelial surfaces (e.g., myocardium, valvular structures). Despite improvements in the diagnosis and treatment of IE, the in-hospital mortality rate persists at almost 20%, reflecting epidemiologic changes such as older patients, more health care-associated infections, and more CIED infections. Diagnosis relies on the modified Duke criteria of multiple blood cultures positive for an organism that typically causes IE and evidence of endocardial involvement that is most commonly provided by echocardiography (e.g., new valvular regurgitation, vegetations, intracardiac abscess, new prosthetic paravalvular regurgitation, prosthetic valve dehiscence, fistula formation). Complications of IE include heart failure due to severe valvular regurgitation and embolic events associated with large vegetations, Staphylococcus aureus infection, and mitral valve involvement. Multidisciplinary care that includes cardiologists, infectious disease specialists, and cardiac surgeons is needed to optimize the antibiotic and surgical treatment of IE and reduce mortality rates..
