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Infectious endocarditis is divided into the following main categories, depending on the main pathogens and related features of antibiotic therapy.

• infectious endocarditis of natural valves;

• infectious endocarditis in drug addicts using the iv route of drug administration;

• infectious endocarditis of artificial (prosthetic) valves:

• early (developing within 60 days after surgery) - more often due to valve contamination or as a result of perioperative bacteremia;

• late (developing more than 2 months after surgery) - may have the same pathogenesis with early infectious endocarditis, but a longer incubation period; may also develop as a result of transient bacteremia.

Acute and subacute infectious endocarditis is distinguished depending on the nature of the course of the disease. However, the most significant is the unit for bacterial etiology, as this determines the choice of AMP and the duration of therapy.

The main pathogens

Infectious endocarditis can be caused by a variety of microorganisms, however, the vast majority are streptococci and staphylococci (80-90%).

The most common pathogens of infectious endocarditis are presented in table. 1.

Table 1. Etiology of Infectious Endocarditis

Acute infectious endocarditis needs immediate antibiotic therapy, while treatment of subacute endocarditis may be delayed for 24-48 hours while a diagnostic examination is being conducted. The need for urgent treatment of acute endocarditis is due to the fact that one of the most likely pathogens is S.aureus, which can cause toxic shock, septic metastases and the rapid destruction of heart valves.

Subacute infectious endocarditis is usually caused by microorganisms characterized by low virulence, and is rarely accompanied by septicemia or shock. A certain delay in the start of treatment makes it possible within 1-2 days to obtain preliminary data from a microbiological blood test and conduct etiotropic therapy. However, it is unacceptable to postpone the start of the use of AMP for more than 48 hours.

To cure infectious endocarditis, it is necessary to achieve the eradication of microorganisms from vegetation, which is possible only if the following main points are observed:

• use AMPs that are active against potential and established pathogens;

• use bactericidal AMPs, since in vegetation microorganisms are in a state of low metabolic activity;

• use combinations of AMPs with synergism;

• Parenteral administration of AMP to obtain higher and predictable serum concentrations;

• antimicrobial therapy should be long to ensure sterilization of valve vegetation.

Empirical Antimicrobial Therapy

Before obtaining the results of a microbiological blood test, empirical antimicrobial therapy of infectious endocarditis should be directed against the main pathogens taking into account the individual characteristics of the patient (Table 2).

Table 2. Empirical antimicrobial therapy of infectious endocarditis

In acute infectious endocarditis, the drugs of choice are AMPs active against S.aureus.

In "iv drug addicts" antibiotic therapy should include drugs that are active against S.aureus and gram-negative rods (in many regions drug users have a high incidence of MRSA).

In infectious endocarditis of artificial valves, vancomycin and gentamicin are the drugs of choice, since MRSE is high.

After obtaining the results of a microbiological blood test, it is necessary to adjust the therapy. In case of negative blood cultures, the ongoing therapy should be continued if it was effective. Recommended combinations of AMP, doses, frequency and duration of their administration depending on the etiology of endocarditis are given in table. 3.

Table 3. Antimicrobial therapy of infectious endocarditis of established etiology (in accordance with the recommendations of the International Society for Chemotherapy, 1998)

There are no significant differences between the etiology of infectious endocarditis in children and adults. Data on optimal antimicrobial therapy in children is limited, with most antimicrobial regimens being borrowed from adults. In general, these regimens were equally effective and less toxic when used in children.


In patients older than 60 years, a slightly higher incidence of infectious endocarditis is observed, which is associated with the presence of complicating factors (diseases of the cardiovascular system). At the same time, in elderly people, a decrease in renal function is observed, which may require a change in doses and / or dosage interval when using penicillins and cephalosporins, vancomycin and aminoglycosides.
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  1. Infectious endocarditis
    Infectious endocarditis is an inflammatory disease of the endothelial lining of the heart of infectious etiology with the localization of the pathological process in the endocardium, heart valves and endothelium of large adjacent vessels. Typical pathological changes are vegetations, which usually form on the heart valves. For a long time this disease was called bacterial
    Lawrence L. Pelletier, Robert G. Petersdorf (Lawrence L. Pelletier, JR., Robert G. Petersdorf) Definition. Infectious (septic) endocarditis is a bacterial infection of the valves of the heart or endocardium that has developed due to the presence of congenital or acquired heart disease. A disease similar in clinical manifestations develops with infection of an arteriovenous fistula or
  3. Infectious endocarditis
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  4. Infectious endocarditis
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  6. Infectious endocarditis (code 133.0)
    Definition Infectious endocarditis is a variant of sepsis that occurs with damage to the endocardium, heart valves, adjacent to the valves of the endocardial sites. Risk groups - patients: • with congenital and acquired valvular heart diseases; • with hypertrophic cardiomyopathy; • with prosthetic heart valves; • with hemodialysis shunts; • undergoing invasive methods
  7. Lecture. Infectious Endocarditis, 2011
    Etiology and pathogenesis of IE, clinical classification of IE, clinic and diagnosis of IE, complications and outcomes of IE, treatment and prevention
  8. Endocardial disease
    617. THE MOST FREQUENTLY CAUSED ENDOCARDIUM INJURY 1) lactobacillus 2) Pseudomonas aeruginosa 3) green streptococci 4) Staphylococcus aureus 5) Meningococci 618. ENDOCARDIUM MAY CAUSE 1) viruses 2) complete infection 619. FACTORS SHOULD BE PREPARED FOR INFECTIOUS ENDOCARDITIS
  9. Acute and subacute endocarditis
    ICD code: 133,138,139 133 Acute and subacute endocarditis 133.0 Acute and subacute infectious endocarditis 133.9 Acute endocarditis, unspecified 138 Endocarditis, valve unspecified 139 Endocarditis and heart valve lesions in diseases classified elsewhere. Included: endocardial damage in candidal infection, gonococcal infection, Liebman-Sachs disease, meningococcal
  10. Inflammation of the inner lining of the heart (endocarditis)
    Endocarditis is an inflammation of the endocardium, which can occur for various reasons. With damage to the heart valves, acquired heart defects occur. Endocarditis is most often a manifestation of heart damage with rheumatism, it can occur with connective tissue diseases. Endocarditis of other origin is divided into infectious and non-infectious. Acute Infectious Endocarditis Acute Infectious
  11. Endocardial disease
    Endocarditis (endocarditis) is an inflammatory process that occurs on the inner lining of the heart. According to localization, valve and parietal endocarditis are distinguished, along the course of acute and chronic, according to the nature of the pathological process - warty and ulcerative. Etiology. Endocarditis is a secondary disease by origin and is a complication of toxic-toxic processes that occur more often
  12. Endocardium
    The heart cavities and all the structures protruding in them - trabeculae, papillary muscles, tendon threads and valves - line the endocardium (its inner membrane). The thickness of the endocardium is inversely proportional to the power of the myocardium - in the atria, especially in the left, it is greater than in the ventricles, especially on the trabeculae or papillary muscles, but everywhere it retains a three-layer structure. From the side of the heart cavities
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