Infective endocarditis: 9 Questions physicians often ask

Antibiotic prophylaxis for endocarditis is strongly recommended for patients with intravascular hardware, including prosthetic valves, automatic implantable cardioverter defibrillators, pacemakers, and left ventricular assist devices. Polymerase chain reaction assays may help identify the culprit agent in culture-negative infective endocarditis (IE). Patients with Staphylococcus aureus bacteremia are at increased risk for IE and require aggressive evaluation. Several newer antistaphyloccal agents-including daptomycin, tigecycline, dalbavancin, and telavancin-show promise for the treatment of endocarditis caused by Gram-positive organisms. In patients with IE, the principal indications for valve repair or replacement are congestive heart failure from valve dysfunction; perivalvular extension, including new-onset conduction abnormalities; persistent fever for 10 or more days despite appropriate antibiotic therapy; large vegetation size; embolic phenomena; or infection with fungi, Pseudomonas aeruginosa, or S aureus.