Update on infective endocarditis.

摘要: With infective endocarditis afflicting 15,000 patients each year and with a mortality rate that still hovers at almost 40%, the disease remains very serious health problem. Surprisingly, incidence has not declined over last 30 years, now more care interventions, such as pacer/defibrillators, an increasingly elderly population degenerative valvular heart disease, number susceptible to is actually increasing. Given weak evidence for prophylaxis, there large risk. Much been learned recently about pathogenesis of endocarditis, including role endothelial damage, platelet adhesion, microbial adherence vegetation or intact tissue. Three-fourths have preexisting structural disease. Once infection manifest, major cardiac complications include congestive failure, embolization, mycotic aneurysms, renal dysfunction, abscess formation. The diagnosis enhanced by modifications in Duke criteria use transesophageal echocardiography antibody titers. Surgery continues play important role, emergency, urgent, early surgery defined. organisms involved streptococci staphylococcus (representing 75% so all cases). Enterococcal infections account many remaining cases, although small series case reports suggest infect humans can be implicated times. A sizeable "culture-negative" cases occur despite improvements diagnostic methodology. Recent guidelines diagnosis, treatment, management from American Heart Association are reviewed issues surrounding prophylaxis summarized. International cooperative databases being developed hold promise continual reexamination epidemiology this highly aggressive may help provide sorely needed prospective trial data will enhance our understanding treatment.