Infective Endocarditis - Diagnosis, Treatment and Specific Situations Management – Current Knowledge, Review of the Literature
DOI:
https://doi.org/10.12775/QS.2025.38.58151Keywords
infective endocarditis, cardiac surgery treatment, endocarditis team, CIED- related infective endocarditisAbstract
Introduction
Infective endocarditis (IE) is a severe condition of endocardium, which can manifest through a wide spectrum of unspecific symptoms related to various organ systems. The diagnosis is made on the basis of the presence of bacteraemia and imaging findings confirming IE visualized in echocardiography, computer tomography and nuclear imaging. Anatomical changes or foci of altered metabolism can be located on the valves, in the perivalvular area or in the area of foreign material (e. g. valves prosthesis or implantable device). Not only the diagnostic process can be challenging, but also the treatment, which consists of antibiotic therapy and cardiac surgery. The indications for surgical treatment depend on patients’ clinical condition, which can change dynamically. Multidisciplinary approach is required to the proper care of the patients.
Aim of the study
The aim of the study is to review the current knowledge of infective endocarditis and the timing indications of cardiac surgery treatment.
Material and methods
This article presents the current knowledge of the diagnosis and treatment in infective endocarditis, especially on the basis of the guidelines of European Society of Cardiology. Literature analysis, especially papers, which contain recent report in infective endocarditis treatment were analysed using the PubMed platform. The search included the keywords: “infective endocarditis”, ,‚surgery treatment of infective endocarditis”, “endocarditis team”, “CIED- related infective endocarditis”.
References
1. Geller SA. Infective endocarditis: a history of the development of its understanding. Autops Case Rep. 2013;3(4):5-12. Published 2013 Dec 31. doi:10.4322/acr.2013.033
2. Li M, Kim JB, Sastry BKS, Chen M. Infective endocarditis. Lancet. 2024;404(10450):377-392. doi:10.1016/S0140-6736(24)01098-5
3. Chen H, Zhan Y, Zhang K, et al. The Global, Regional, and National Burden and Trends of Infective Endocarditis From 1990 to 2019: Results From the Global Burden of Disease Study 2019. Front Med (Lausanne). 2022;9:774224. Published 2022 Mar 9. doi:10.3389/fmed.2022.774224
4. Hammond-Haley M, Hartley A, Al-Khayatt BM, et al. Trends in the incidence and mortality of infective endocarditis in high-income countries between 1990 and 2019. Int J Cardiol. 2023;371:441-451. doi:10.1016/j.ijcard.2022.09.061
5. Yucel E, Bearnot B, Paras ML, et al. Diagnosis and Management of Infective Endocarditis in People Who Inject Drugs: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(20):2037-2057. doi:10.1016/j.jacc.2022.03.349
6. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis [published correction appears in Eur Heart J. 2023 Dec 1;44(45):4780. doi: 10.1093/eurheartj/ehad625] [published correction appears in Eur Heart J. 2024 Jan 1;45(1):56. doi: 10.1093/eurheartj/ehad776]. Eur Heart J. 2023;44(39):3948-4042. doi:10.1093/eurheartj/ehad193
7. Cosyns B, Habib G. Endocardites infectieuses et cancers : résultats du registre EURO-ENDO [Infectious endocarditis and cancers: results of the EURO-ENDO registry]. Rev Prat. 2024;74(6):664-665.
8. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169(5):463-473. doi:10.1001/archinternmed.2008.603
9. La Scola B, Raoult D. Direct identification of bacteria in positive blood culture bottles by matrix-assisted laser desorption ionisation time-of-flight mass spectrometry. PLoS One. 2009;4(11):e8041. Published 2009 Nov 25. doi:10.1371/journal.pone.0008041
10. Kong WKF, Salsano A, Giacobbe DR, et al. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry [published correction appears in Eur Heart J. 2023 Jun 1;44(21):1909. doi: 10.1093/eurheartj/ehad222]. Eur Heart J. 2022;43(29):2770-2780. doi:10.1093/eurheartj/ehac307
11. Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11(2):202-219. doi:10.1093/ejechocard/jeq004
12. Bai AD, Steinberg M, Showler A, et al. Diagnostic Accuracy of Transthoracic Echocardiography for Infective Endocarditis Findings Using Transesophageal Echocardiography as the Reference Standard: A Meta-Analysis. J Am Soc Echocardiogr. 2017;30(7):639-646.e8. doi:10.1016/j.echo.2017.03.007
13. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075-3128. doi:10.1093/eurheartj/ehv319
14. Saxena P, Malouf JF, Click R, Suri RM. 3D echocardiography in cardiac surgery. J Card Surg. 2014;29(1):51-54. doi:10.1111/jocs.12256
15. Liu YW, Tsai WC, Lin CC, et al. Usefulness of real-time three-dimensional echocardiography for diagnosis of infective endocarditis. Scand Cardiovasc J. 2009;43(5):318-323. doi:10.1080/14017430902737940
16. Hryniewiecki T, Zatorska K, Abramczuk E, et al. The usefulness of cardiac CT in the diagnosis of perivalvular complications in patients with infective endocarditis. Eur Radiol. 2019;29(8):4368-4376. doi:10.1007/s00330-018-5965-2
17. El Ouazzani J, Jandou I, Christophe Thuaire I. Thrombus or vegetation?Importance of cardiac MRI as a diagnostic tool based on case report and literature review. Ann Med Surg (Lond). 2020;60:690-694. Published 2020 Dec 5. doi:10.1016/j.amsu.2020.12.007
18. Duval X, Iung B, Klein I, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010;152(8):497-W175. doi:10.7326/0003-4819-152-8-201004200-00006
19. Haller S, Vernooij MW, Kuijer JPA, Larsson EM, Jäger HR, Barkhof F. Cerebral Microbleeds: Imaging and Clinical Significance. Radiology. 2018;287(1):11-28. doi:10.1148/radiol.2018170803
20. Wang TKM, Sánchez-Nadales A, Igbinomwanhia E, Cremer P, Griffin B, Xu B. Diagnosis of Infective Endocarditis by Subtype Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Contemporary Meta-Analysis. Circ Cardiovasc Imaging. 2020;13(6):e010600. doi:10.1161/CIRCIMAGING.120.010600
21. Germaini M, Boursier C, Goehringer F, et al. The detection of infectious endocarditis may be enhanced by a repeat FDG-PET while maintaining patients on a ketogenic diet. J Nucl Cardiol. 2022;29(6):3256-3262. doi:10.1007/s12350-022-02921-w
22. Hyafil F, Rouzet F, Lepage L, et al. Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography. Eur Heart J Cardiovasc Imaging. 2013;14(6):586-594. doi:10.1093/ehjci/jet029
23. Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019;380(5):415-424. doi:10.1056/NEJMoa1808312
24. Pericàs JM, Hernández-Meneses M, Muñoz P, et al. Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study. Open Forum Infect Dis. 2021;8(6):ofab119. Published 2021 Mar 25. doi:10.1093/ofid/ofab119
25. López J, Sevilla T, Vilacosta I, et al. Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. Rev Esp Cardiol (Engl Ed). 2013;66(5):384-390. doi:10.1016/j.rec.2012.10.022
26. Nadji G, Rusinaru D, Rémadi JP, Jeu A, Sorel C, Tribouilloy C. Heart failure in left-sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment. Eur J Heart Fail. 2009;11(7):668-675. doi:10.1093/eurjhf/hfp077
27. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med. 2012;366(26):2466-2473. doi:10.1056/NEJMoa1112843
28. Voigt A, Shalaby A, Saba S. Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing Clin Electrophysiol. 2010;33(4):414-419. doi:10.1111/j.1540-8159.2009.02569.x
29. Blomström-Lundqvist C, Traykov V, Erba PA, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace. 2020;22(4):515-549. doi:10.1093/europace/euz246
30. Selton-Suty C, Célard M, Le Moing V, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012;54(9):1230-1239. doi:10.1093/cid/cis199
31. Moriyama N, Laakso T, Biancari F, et al. Prosthetic valve endocarditis after transcatheter or surgical aortic valve replacement with a bioprosthesis: results from the FinnValve Registry. EuroIntervention. 2019;15(6):e500-e507. Published 2019 Aug 9. doi:10.4244/EIJ-D-19-00247
32. Fauchier L, Bisson A, Herbert J, et al. Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement. Clin Microbiol Infect. 2020;26(10):1368-1374. doi:10.1016/j.cmi.2020.01.036
33. Wahadat AR, Tanis W, Swart LE, et al. Added value of 18F-FDG-PET/CT and cardiac CTA in suspected transcatheter aortic valve endocarditis. J Nucl Cardiol. 2021;28(5):2072-2082. doi:10.1007/s12350-019-01963-x
34. Stortecky S, Heg D, Tueller D, et al. Infective Endocarditis After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020;75(24):3020-3030. doi:10.1016/j.jacc.2020.04.044
35. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2019 May 14;73(18):2361. doi: 10.1016/j.jacc.2019.03.017]. J Am Coll Cardiol. 2019;73(12):1494-1563. doi:10.1016/j.jacc.2018.08.1028
36. Rushani D, Kaufman JS, Ionescu-Ittu R, et al. Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors. Circulation. 2013;128(13):1412-1419. doi:10.1161/CIRCULATIONAHA.113.001827
37. Kuijpers JM, Koolbergen DR, Groenink M, et al. Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease: focus on the use of prosthetic material. Eur Heart J. 2017;38(26):2048-2056. doi:10.1093/eurheartj/ehw591
38. Moore B, Cao J, Kotchetkova I, Celermajer DS. Incidence, predictors and outcomes of infective endocarditis in a contemporary adult congenital heart disease population. Int J Cardiol. 2017;249:161-165. doi:10.1016/j.ijcard.2017.08.035
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