Native-Valve Infective Endocarditis

Native-Valve Infective Endocarditis The modified Duke criteria, which are based on findings on physical examination, echocardiography, microbiologic studies, and computed tomographic and magnetic resonance imaging of target organs, are sensitive and specific for the clinical diagnosis of infective endocarditis. Transesophageal echocardiography, which is more sensitive than transthoracic echocardiography (TTE) for identifying valvular vegetations and periannular complications of infective endocarditis, is indicated when TTE is negative or nondiagnostic. Beta-lactam antibiotics are recommended over vancomycin or daptomycin for treatment of infective endocarditis caused by methicillin-susceptible Staphylococcus aureus. In older patients with infective endocarditis caused by Enterococcus faecalis, especially those with underlying renal disease or those receiving other nephrotoxic agents, ampicillin plus ceftriaxone is preferred over aminoglycoside-containing regimens. Early surgery for uncontrolled infection, congestive heart failure caused by valvular dysfunction, or prevention of central nervous system embolization is associated with improved outcomes. A transition to an oral step-down regimen after an initial intravenous course of therapy may be considered in selected patients. The diagnosis of infectious endocarditis is based on modified Duke criteria, according to findings on physical examination, echocardiography, microbiologic studies, and imaging of target organs. The selection and duration of antibiotic treatment depend on culture results. Early surgery is indicated in some patients.