Endocardite infectieuse : quoi de neuf ? Recommandations de l’ European Society of Cardiology (ESC) 2009

Abstract

Infective endocarditis (IE) is a severe form of valve disease still associated with a high mortality (10-26 % in-hospital mortality). IE is a rare disease, with reported incidences ranging from 3 to 10 episodes/100,000 people per year. The epidemiological profile of IE has changed over the last few years, with newer predisposing factors - valve prostheses, degenerative valve sclerosis, intravenous drug abuse (IVDA), associated with the increased use of invasive procedures at risk for bacteremia. Health care-associated IE represents up to 30 % cases of IE, justifying aseptic measures during venous catheters manipulation and during any invasive procedures. There is a lack of scientific evidence for the efficacy of infective endocarditis prophylaxis. Thus, antibiotic prophylaxis is recommended only for patients with the highest risk of IE undergoing the highest risk dental procedures. Good oral hygiene and regular dental review have a very important role in reducing the risk of IE. Echocardiography and blood cultures are the cornerstone of diagnosis of IE. TTE must be performed first, but both TTE and TEE should ultimately be performed in the majority of cases of suspected or definite IE. The treatment of IE relies on the combination of prolonged antimicrobial therapy and - in about half patients - surgical eradication of the infected tissues. The 3 main complications of IE indicating early surgery are heart failure (HF), uncontrolled infection, and prevention of embolic events. HF is the most frequent and severe complication of IE. Unless severe comorbidity exists, the presence of HF indicates early surgery. The new guidelines give for the first time informations not only on the indications of surgery, but also on the timing of surgery.