Abstract
Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use “low fouling coats” with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.
Highlights
The challenges posed by infections developing in native heart tissue or implanted devices are greater than ever
Given the constant evolution of infections associated with implants and implantable devices in cardiopathic patients, an evaluation of therapeutic and innovative biomaterials against medical device-associated infections, 2 crucial challenges should be considered: preventive therapy against the most aggressive strains of pathogens and the infection of heart devices including conventional mechanical or biological prosthesis, transcatheter heart valve implantation (THVI), and cardiac implantable electronic devices (CIEDs)
Concern related to the clinical picture of patients with endocarditis sustained by Staphylococcus aureus is the high aggressiveness of the infection which frequently causes complications such as an increased risk of embolism and stroke
Summary
The challenges posed by infections developing in native heart tissue or implanted devices are greater than ever. The current era is characterized by remarkable advances in the field of cardiology with noticeable changes in patient demographics and disease manifestations [1, 2] This change affects the average patient who is older and frail with increasing comorbidities. The caveat, is that TAVI may be associated with higher rates of IE compared to conventional surgery [6,7,8,9] Another aspect to consider is healthcare-associated infection, which is the result of complicated care in patients who have received the generation of cardiac devices. Despite the burden of healthcare-associated infections in highincome countries being significantly lower than those occurring in low-income countries [10], there is irrefutable evidence highlighting the need to improve surveillance and infection control practices This inconvenience in routine patient management has a major impact leading to increased. Given the constant evolution of infections associated with implants and implantable devices in cardiopathic patients, an evaluation of therapeutic and innovative biomaterials against medical device-associated infections, 2 crucial challenges should be considered: preventive therapy against the most aggressive strains of pathogens and the infection of heart devices including conventional mechanical or biological prosthesis, transcatheter heart valve implantation (THVI), and CIED
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