Download PDF
Kardiologie up2date 2022; 18(02): 153-169
DOI: 10.1055/a-1649-1381
Herzklappenerkrankungen

Infektiöse Endokarditis – Update

Sems Malte Tugtekin
,
Pascal Schöne
,
Manuel Wilbring
,
Utz Kappert
,
Konstantin Alexiou
,
Klaus Matschke
› Further Information
Also available at
    Permissions and Reprints All articles of this category

Patienten mit infektiöser Endokarditis sind oft multimorbid und in kritischem klinischen Zustand. Der klinische Verlauf der Erkrankung und ihrer Komplikationen erfordern maximale kardiale und extrakardiale Therapiemaßnahmen. Aktuelle Ansätze betreffen dabei die 3 Bausteine Prävention, Diagnostik und Therapie. Im Folgenden werden Neuentwicklungen in den genannten Bereichen detaillierter betrachtet und mögliche klinische Implikationen diskutiert.
Kernaussagen

  • Die infektiöse Endokarditis ist eine seltene, aber unverändert lebensbedrohliche Erkrankung mit einer Gesamtmortalität von 20%.

  • Es werden 2 klinische Verlaufsformen unterschieden: die Endokarditis der Nativklappen und die Prothesenendokarditis.

  • Die Diagnose der Erkrankung orientiert sich neben den klinischen Symptomen einer Infektionserkrankung und mikrobiologischen Verfahren an der Bildgebung, vor allem an der transösophagealen Echokardiografie.

  • Extrakardiale Komplikationen können oft zur Verzögerung der Diagnosestellung führen.

  • Die Therapie einer infektiösen Endokarditis orientiert sich an 2 Eckpfeilern: der medikamentös antibiotischen Therapie und der kardiochirurgischen Sanierung – häufig ist ein kombiniertes Vorgehen nötig.

  • Die kardiochirurgische Therapie strebt eine Wiederherstellung der Klappenfunktionen unter radikaler Entfernung von infiziertem Material an.

  • Die Prognose der Erkrankung ist von einer frühzeitigen Diagnosesicherung abhängig.

  • Die Festlegung der adäquaten Therapie setzt ein interdisziplinäres Vorgehen voraus.

  • Spezielle Risikoscores könnten zur verbesserten individuellen Therapie beitragen.

Schlüsselwörter

infektiöse Endokarditis - Antibiotika - Herzchirurgie


Publication History

Article published online:
01 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Østergaard L, Oestergaard LB, Lauridsen TK. et al. Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment: a nationwide population-based study. Eur J Cardiothorac Surg 2018; 54: 860-866
    CrossrefPubMedSearch in Google Scholar
  • 2 Habib G, Lancellotti P, Antunes MJ. et al. ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128
    CrossrefPubMedSearch in Google Scholar
  • 3 Suda KJ, Henschel H, Patel U. et al. Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures. Open Forum Infect Dis 2017; 5: ofx250
    CrossrefPubMedSearch in Google Scholar
  • 4 Garg P, Ko DT, Bray Jenkyn KM. et al. Infective Endocarditis Hospitalizations and Antibiotic Prophylaxis Rates Before and After the 2007 American Heart Association Guideline Revision. Circulation 2019; 140: 170-180
    CrossrefPubMedSearch in Google Scholar
  • 5 Dayer MJ, Jones S, Prendergast B. et al. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis. Lancet 2015; 385(9974): 1219-1228
    CrossrefPubMedSearch in Google Scholar
  • 6 Böhmer F, Hornung A, Burmeister U. et al. Factors, Perceptions and Beliefs Associated with Inappropriate Antibiotic Prescribing in German Primary Dental Care: A Qualitative Study. Antibiotics (Basel) 2021; 10: 987
    CrossrefPubMedSearch in Google Scholar
  • 7 Butany J, Leask RL, Desai ND. et al. Pathologic analysis of 19 heart valves with silver-coated sewing rings. J Card Surg 2006; 21: 530-538
    CrossrefPubMedSearch in Google Scholar
  • 8 Scully IL, Timofeyeva Y, Illenberger A. et al. Performance of a Four-Antigen Staphylococcus aureus Vaccine in Preclinical Models of Invasive S. aureus Disease. Microorganisms 2021; 9: 177
    CrossrefPubMedSearch in Google Scholar
  • 9 Cahill TJ, Baddour LM, Habib G. et al. Challenges in Infective Endocarditis. J Am Coll Cardiol 2017; 69: 325-344
    CrossrefPubMedSearch in Google Scholar
  • 10 Barbieri A, Mantovani F, Lugli R. et al. European Society of Cardiology-Proposed Diagnostic Echocardiographic Algorithm in Elective Patients with Clinical Suspicion of Infective Endocarditis: Diagnostic Yield and Prognostic Implications in Clinical Practice. J Cardiovasc Echogr 2018; 28: 26-31
    CrossrefPubMedSearch in Google Scholar
  • 11 Afonso L, Kottam A, Reddy V. et al. Echocardiography in Infective Endocarditis: State of the Art. Curr Cardiol Rep 2017; 19: 127
    CrossrefPubMedSearch in Google Scholar
  • 12 Nappi F, Singh SSA, Nappi P. et al. Heart Valve Endocarditis. Surg Technol Int 2020; 37: 203-215
    PubMedSearch in Google Scholar
  • 13 Wang TKM, Bin Saeedan M, Chan N. et al. Complementary Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis. Circ Cardiovasc Imaging 2020; 13: e011126
    CrossrefPubMedSearch in Google Scholar
  • 14 Nuvoli S, Fiore V, Babudieri S. et al. The additional role of 18F-FDG PET/CT in prosthetic valve endocarditis. Eur Rev Med Pharmacol Sci 2018; 22: 1744-1751
    CrossrefPubMedSearch in Google Scholar
  • 15 Murphy DJ, Din M, Hage FG. et al. Guidelines in review: Comparison of ESC and AHA guidance for the diagnosis and management of infective endocarditis in adults. J Nucl Cardiol 2019; 26: 303-308
    CrossrefPubMedSearch in Google Scholar
  • 16 Boujelben I, Gdoura R, Hammami A. A broad-range PCR technique for the diagnosis of infective endocarditis. Braz J Microbiol 2018; 49: 534-543
    CrossrefPubMedSearch in Google Scholar
  • 17 Kim B, Kim SH, Kim T. Cerebral Infarcts by Nonbacterial Thrombotic Endocarditis Associated with Adenomyosis: A Case Report. J Stroke Cerebrovasc Dis 2018; 27: e50-e53
    CrossrefPubMedSearch in Google Scholar
  • 18 Hoerr V, Franz M, Pletz MW. et al. S. aureus endocarditis: Clinical aspects and experimental approaches. Int J Med Microbiol 2018; 308: 640-652
    CrossrefPubMedSearch in Google Scholar
  • 19 Wang A, Gaca JG, Chu VH. Management Considerations in Infective Endocarditis: A Review. JAMA 2018; 320: 72-83
    CrossrefPubMedSearch in Google Scholar
  • 20 Goenaga Sánchez MÁ, Kortajarena Urkola X, Bouza Santiago E. et al. Aetiology of renal failure in patients with infective endocarditis. The role of antibiotics. Med Clin (Barc) 2017; 149: 331-338
    PubMedSearch in Google Scholar
  • 21 Al-Omari A, Cameron DW, Lee C. et al. Oral antibiotic therapy for the treatment of infective endocarditis: a systematic review. BMC Infect Dis 2014; 14: 140
    CrossrefPubMedSearch in Google Scholar
  • 22 Iversen K, Ihlemann N, Gill SU. et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med 2019; 380: 415-424
    CrossrefPubMedSearch in Google Scholar
  • 23 Rezar R, Jirak P, Lichtenauer M. et al. Partial oral antibiotic therapy is non-inferior to intravenous therapy in non-critically ill patients with infective endocarditis: Review and meta-analysis. Wien Klin Wochenschr 2020; 132: 762-769
    CrossrefPubMedSearch in Google Scholar
  • 24 Wang A, Chu VH, Athan E. et al. Investigator Association between the timing of surgery for complicated, left-sided infective endocarditis and survival. Am Heart J 2019; 210: 108-116
    CrossrefPubMedSearch in Google Scholar
  • 25 Wilbring M, Tugtekin SM, Alexiou K. et al. Composite aortic root replacement for complex prosthetic valve endocarditis: initial clinical results and long-term follow-up of high-risk patients. Ann Thorac Surg 2012; 94: 1967-1974
    CrossrefPubMedSearch in Google Scholar
  • 26 Nappi F, Singh SSA, Spadaccio C. et al. Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis. Ann Transl Med 2020; 8: 952
    CrossrefPubMedSearch in Google Scholar
  • 27 Tugtekin SM, Alexiou K, Wilbring M. et al. Native infective endocarditis: which determinants of outcome remain after surgical treatment?. Clin Res Cardiol 2006; 95: 72-79
    CrossrefPubMedSearch in Google Scholar
  • 28 Havers-Borgersen E, Butt JH, Østergaard L. et al. Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery. Clin Res Cardiol 2020; 109: 1342-1351
    CrossrefPubMedSearch in Google Scholar
  • 29 Otto CM. Heartbeat: Surgical risk scores in infective endocarditis. Heart 2017; 103: 1391-1393
    CrossrefPubMedSearch in Google Scholar
  • 30 Torre-Lima J, Lomas JM, Hidalgo-Tenorio C. et al. A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE. Clin Microbiol Infect 2018; 24: 1102.e7-1102.e15
    CrossrefPubMedSearch in Google Scholar
  • 31 Cahill TJ, Prendergast BD. Current controversies in infective endocarditis. F1000Res 2015; 4: F1000 Faculty Rev-1287
    CrossrefPubMedSearch in Google Scholar
  • 32 Wilbring M, Irmscher L, Alexiou K. et al. The impact of preoperative neurological events in patients suffering from native infective valve endocarditis. Cardiovasc Thorac Surg 2014; 18: 740-747
    PubMedSearch in Google Scholar
  • 33 Bonaros N, Czerny M, Pfausler B. et al. Infective endocarditis and neurologic events: indications and timing for surgical interventions. Eur Heart J Suppl 2020; 22 (Suppl M) M19-M25
    CrossrefPubMedSearch in Google Scholar
  • 34 Østergaard L, Lauridsen TK, Iversen K. et al. Infective endocarditis in patients who have undergone transcatheter aortic valve implantation: a review. Clin Microbiol Infect 2020; 26: 999-1007
    CrossrefPubMedSearch in Google Scholar
  • 35 Tinica G, Tarus A, Enache M. et al. Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences. Rev Cardiovasc Med 2020; 21: 263-274
    CrossrefPubMedSearch in Google Scholar
  • 36 Russo M, Andreas M, Taramasso M. et al. Prosthetic valve endocarditis involving the MitraClip device. J Card Surg 2017; 32: 696-697
    CrossrefPubMedSearch in Google Scholar
  • 37 Kaura A, Byrne J, Fife A. et al. Inception of the ‘endocarditis team’ is associated with improved survival in patients with infective endocarditis who are managed medically: findings from a before-and-after study. Open Heart 2017; 4: e000699
    CrossrefPubMedSearch in Google Scholar
  • 38 Habib G, Lancellotti P, Erba PA. et al. The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes 2019; 5: 202-207
    CrossrefPubMedSearch in Google Scholar