Infective Endocarditis

Infective Endocarditis is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Epidemiology

  • Rising incidence of acute bacterial endocarditis (ABE) and health care-associated endocarditis (related to IV catheters and invasive procedures) in recent times has been driven by increased rates of S. aureus bacteremia.
  • Prosthetic valve endocarditis (PVE) occurs in 3%–6% of patients with prosthetic heart valves.

Etiology

  • Infective endocarditis (IE) is usually caused by gram-positive cocci. S. aureus is the most common pathogen followed by viridans group streptococci, enterococci, and coagulase-negative staphylococci.
  • Enterococcus species cause 5%–10% of cases of subacute bacterial endocarditis (SBE).
  • Gram-negative and fungal IE occur infrequently and are usually associated with injection drug use or prosthetic heart valves.
  • Bacteremia from distant foci of infection or dental procedures are frequent seeding events.
  • Early PVE (within the first year of surgery) commonly occurs in the first 2 months and is typically caused by S. aureus, coagulase-negative staphylococci, gram-negative bacilli, and Candida spp.
  • Late-onset PVE is caused by the same organisms seen in native valve endocarditis.

Risk Factors

Structural heart disease (e.g., degenerative valve disease), IV drug use, prosthetic heart valves, intravascular devices, chronic hemodialysis, and a prior history of endocarditis are predisposing factors for endocarditis.

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