Prevention and treatment of infectious endocarditis – evidence-based medicine approach in the European Society of Cardiology’s Guidelines

Abstract

The article presents recommendations on infectious endocarditis (IE) prevention and treatment, according to the latest evidence on risk-benefit ratio for each intervention. IE in anamnesis, prosthetic valves or other artificial implants, surgery-created ducts, complicated congenital heart disease with cyanosis, are regarded as high-risk situations. IE prevention, focused on Streptococcus viridans and NACEK microorganisms before dental, respiratory or esophageal interventions, and on Enterococci and Streptococcus bovis before gastro-intestinal and urogenital interventions, is performed with amoxicillin and clindamycin. Ethiotropic antimicrobial therapy includes penicillins, cephalosporins, aminoglycosides, and vancomycine. Indications for surgery are: heart failure due to acute aortic or mitral regurgitation; resistant fever and bacteriemia for 8 days and longer, despite adequate antimicrobial therapy; abscesses, fistulas, ruptures of one or more valves; heart blocks; myocarditis – the signs of process dissemination, and antibiotic-resistant flora involvement (fungi, Brucella, Coxiella).