Management of Endocarditis

Infective endocarditis occurs when bacteria or fungi in the bloodstream infect the inner lining of the heart (endocardium), typically of a heart valve. Up to 40–50% of IE cases are caused by Staphylococcal aureus. The clinical manifestations of endocarditis are broad and multisystem. From a cardiac perspective, there may be valvular incompetence from direct destruction; rupture of papillary muscles and ventricular walls; pericarditis; myocardial abscess formation; or complete heart block. Treatment of IE begins with empiric antibiotic therapy which is then tailored to specific organisms isolated in blood cultures. Factors determining whether to operate include the patient’s hemodynamic status, left vs. right-sided pathology, risk of thromboembolic complication, and likelihood of source control with non-invasive treatments. Surgical candidacy and timing can be further complicated by recent stroke/mycotic aneurysms, abscesses/source control, psychosocial issues including IV drug use and non-compliance, and center expertise.