Document Detail


New aspects of infective endocarditis.
MedLine Citation:
PMID:  15284678     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The current incidence of infective endocarditis (IE) is estimated as 7 cases per 100,000 population per year and continues to increase. The prognosis is significantly influenced by proper diagnosis and adequate therapy. In cases with unconfirmed IE, transesophageal echocardiography is the imaging technique of choice. Culture-negative endocarditis requires either termination of antimicrobial treatment initiated without mircobiological test results and reevaluation of blood samples or serological/molecular biological techniques to identify the causative organism. Antimicrobial therapy should be established only after quantitative sensitivity tests of antibiotics (minimal inhibitory concentrations, MIC) and guided by drug monitoring. In the first 3 weeks after primary manifestation, an index embolism is frequently followed by recurrencies. If vegetations can still be demonstrated by echocardiography after an embolic event, a surgical intervention should seriously be considered. Cerebral embolic events are no contraindication for cardiac surgery, as long as a cerebral bleeding has been excluded by cranial computed tomography immediately preoperatively and the operation is performed before a significant disturbance of the blood-brain barrier (<72 hours) has manifested. A significant prognostic improvement has also been demonstrated for patients with early surgical intervention suffering from myocardial failure due to acute valve incompetence, acute renal failure, mitral kissing vegetations in primary aortic valve IE, and in patients with sepsis persisting for more than 48 hours despite adequate antimicrobial therapy.
Authors:
D Horstkotte; C Piper
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Minerva cardioangiologica     Volume:  52     ISSN:  0026-4725     ISO Abbreviation:  Minerva Cardioangiol     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-30     Completed Date:  2004-12-21     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0400725     Medline TA:  Minerva Cardioangiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  273-86     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Heart Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. akohlstaedt@hdz-nrw.de
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MeSH Terms
Descriptor/Qualifier:
Aminoglycosides / therapeutic use
Amphotericin B / therapeutic use
Antifungal Agents / therapeutic use
Drug Combinations
Drug Therapy, Combination / therapeutic use
Echocardiography, Transesophageal
Endocarditis, Bacterial* / diagnosis,  microbiology,  therapy
Flucytosine / therapeutic use
Humans
Penicillins / therapeutic use
Prognosis
Vancomycin / therapeutic use
Chemical
Reg. No./Substance:
0/Aminoglycosides; 0/Antifungal Agents; 0/Drug Combinations; 0/Penicillins; 1397-89-3/Amphotericin B; 1404-90-6/Vancomycin; 2022-85-7/Flucytosine

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