Infective endocarditis: Prevention, diagnosis, and treatment

Antibiotic prophylaxis for endocarditis is strongly recommended in patients with intravascular hardware, including prosthetic valves, automatic implantable cardioverter defibrillators, pacemakers, and left ventricular assist devices. Polymerase chain reaction can be useful in diagnosing culture-negative infective endocarditis (IE). Several newer drugs that may be effective for treatment of endocarditis caused by Gram-positive organisms are available or under study. In patients with IE, valve repair or replacement is indicated if there is 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 Staphylococcus aureus.