Cardiovascular infections - recent progress and future challenges

Abstract

Patients with previous endocarditis are at highest risk of infective endocarditis (266-fold compared to the general population) - preventive strategies are of particular importance in this patient subgroup. Patients with community-acquired E. faecalis bacteremia should undergo transesophageal echocardiography - according to a recent study the prevalence of endocarditis may be ≥ 20 % in this setting. Several smaller observational studies suggest an association between E. faecalis endocarditis and colorectal neoplasias - colonoscopy should therefore be offered to patients with newly diagnosed E. faecalis endocarditis (particularly in patients with unknown portal of entry). The non-inferiority of partial oral endocarditis treatment has been demonstrated in a selected subgroup of patients characterized by a stable condition/course, small vegetations and the absence of perivalvular complications. Uncritical and early oralisation of endocarditis treatment in patients not fulfilling these criteria may lead to adverse treatment outcomes. Approximately one out three patients with a left ventricular assist device (LVAD) will suffer from LVAD-related infections during the first year after implantation. Appropriate antibiotic treatment and adequate surgical debridement are essential management strategies.