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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Differentiate the causes and development of infective endocarditis (IE).

  2. Identify the clinical presentation and laboratory evaluation for IE.

  3. Assess diagnostic criteria used to evaluate a patient suspected of having IE.

  4. Describe the most likely causative organisms of IE, particularly in specific patient populations.

  5. Develop appropriate pharmacologic treatment recommendations for patients with IE.

  6. Define appropriate patient populations requiring prophylactic treatment, and differentiate appropriate drug regimens.

  7. Devise a monitoring plan for patients with IE to determine treatment efficacy and discern any adverse effects.

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KEY CONCEPTS

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  • Image not available. For infective endocarditis (IE) to develop, several factors are required, including alterations to the endocardial surface that allow bacterial adherence and eventual infection.

  • Image not available. Persistent fever is the most common symptom present in patients with IE.

  • Image not available. Blood cultures are the essential laboratory test for the diagnosis and treatment of IE. Typically, patients with IE have a low-grade consistent bacteremia. Blood culture results are critical for determining the most appropriate therapy.

  • Image not available. Echocardiograms are used for detecting the presence of a vegetation. Either a transthoracic echocardio-gram (TTE) or a transesophageal echocardiogram (TEE) may be used depending on certain patient characteristics.

  • Image not available. Choosing the appropriate antimicrobial therapy is crucial to achieve adequate organism kill.

  • Image not available. An extended treatment course of 4 to 6 weeks (in most cases) is required to achieve an adequate cure.

  • Image not available. The overall goal of therapy is to eradicate the infection and minimize/prevent any complications.

  • Image not available. In an effort to prevent the development of IE, prophylactic treatment generally is considered appropriate for patients with high-risk factors.

  • Image not available. Monitoring the patient's clinical course is necessary to assess the effectiveness of therapy, detect the potential development of bacterial resistance, and determine outcome.

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Infective endocarditis (IE) is a serious infection affecting the lining and valves of the heart. Although this disease is mostly associated with infection of the heart valves, the septal defects may become involved in some cases. Infections also occur in patients with prosthetic or mechanical devices or who are intravenous drug users (IVDUs). Bacteria are the primary cause of IE; however, fungi and atypical organisms may also be responsible pathogens.

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Typically IE is classified into two categories: acute or subacute. The difference between the two categories is based on the progression and severity of the disease. Acute disease is more aggressive, characterized by high fevers, leukocytosis, and systemic toxicity, with death occurring within a few days to weeks. This type of IE is often caused by more virulent organisms, particularly Staphylococcus aureus. Subacute disease is typically caused by less virulent organisms, such as viridans group streptococci, producing a slower and more subtle presentation. It is characterized by weakness, fatigue, low-grade fever, night sweats, weight loss, and other nonspecific symptoms, with death occurring in several months.

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Successful management of patients with IE is based on proper diagnosis, treatment with adequate therapy, and monitoring for ...

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