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Abstract
The modified Duke criteria, which are based on findings on physical examination, echocardiography, microbiologic studies, and computed tomographic and magnetic resonance imaging of target organs, are sensitive and specific for the clinical diagnosis of infective endocarditis. Transesophageal echocardiography, which is more sensitive than transthoracic echocardiography (TTE) for identifying valvular vegetations and periannular complications of infective endocarditis, is indicated when TTE is negative or nondiagnostic. Beta-lactam antibiotics are recommended over vancomycin or daptomycin for treatment of infective endocarditis caused by methicillin-susceptible Staphylococcus aureus. In older patients with infective endocarditis caused by Enterococcus faecalis, especially those with underlying renal disease or those receiving other nephrotoxic agents, ampicillin plus ceftriaxone is preferred over aminoglycoside-containing regimens. Early surgery for uncontrolled infection, congestive heart failure caused by valvular dysfunction, or prevention of central nervous system embolization is associated with improved outcomes. A transition to an oral step-down regimen after an initial intravenous course of therapy may be considered in selected patients.
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1 From the Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (H.F.C.); and the Division of Infectious Diseases, Harbor–UCLA (University of California, Los Angeles) Medical Center, and the David Geffen School of Medicine at UCLA, Los Angeles, and the Lundquist Institute, Torrance — both in California (A.S.B.).