[Management of patients with infectious endocarditis]

Abstract

The paper presents clinical manifestations of infectious endocarditis (IE), its new clinical classification, diagnostic criteria, potentialities and limitations of echocardiography. General principles of management of patients with IE are considered. The management algorithm is given, which involves the initial assessment of these patients, empirical therapy, etiotropic chemotherapy (CT) regimens in streptococcal, staphylococcal, gram-negative, fungal endocarditis, and IE of unknown etiology. Possible complications due to IE (refractory heart failure, infection dissemination, thrombohemorrhagic syndrome, immune diseases, persistent fever) are described, which need supplementary treatment, particularly schemes for correction of hemostatic and immune disorders. Clinical and microbiological criteria are proposed for evaluating the efficiency of treatment for IE. The conditions showing a higher risk for the types of IE that require antibiotic prophylaxis and the criteria for choosing its regimen are given. New trends in the treatment of IE, such as shorter courses of antibacterial CT, stepwise antibacterial therapy (ABT), and parenteral ABT at home, are outlined.