Infective endocarditis is a rare but life-threatening condition in which bacteria infect the heart valves or endocardial surfaces, forming infected masses known as vegetations. Without appropriate treatment, the condition can be fatal.
What it is
Infective endocarditis occurs when bacteria adhere to heart valves or endocardial surfaces, leading to infection and vegetation formation.
The incidence is estimated at 2–6 cases per 100,000 people per year. Risk factors include valvular heart disease, congenital heart disease, prosthetic valves, poor dental hygiene, long-term dialysis, injection drug use, and immunocompromised states.
Causative organisms
Streptococci were historically the most common causative organisms, but Staphylococcus aureus has become increasingly prevalent.
Other pathogens include enterococci and fungi.
Symptoms and clinical features
Symptoms reflect infection, embolic events, and valvular destruction. Persistent fever is common.
Patients may also experience shortness of breath, fatigue, night sweats, weight loss, or general malaise. Cutaneous or peripheral signs may be present.
Embolic complications occur in a significant proportion of patients. Cerebral embolism may result in stroke or mycotic aneurysm, while other organs such as the spleen, kidneys, or intestines may also be affected.
Diagnosis
A heart murmur is often present on examination.
Echocardiography is central to diagnosis and can detect vegetations and valvular dysfunction. Blood cultures identify the causative organism, and inflammatory markers are typically elevated.
Diagnosis is based on clinical findings, blood cultures, and echocardiographic evidence.
Our treatment
Treatment addresses both infection and cardiac complications. Prolonged intravenous antibiotic therapy is the primary approach.
Heart failure management may be required, including diuretics and inotropic support.
Surgical intervention is indicated when infection is uncontrolled, heart failure progresses, or embolic risk is high.
Surgical indications and procedure
- Failure of antibiotic therapy
- Progressive heart failure
- Large vegetations (approximately ≥10 mm)
Surgery involves removal of infected tissue followed by valve repair or replacement. When infection extends beyond the valve, reconstruction of adjacent structures may be required.
Postoperative care
Intravenous antibiotics are continued for approximately six weeks after surgery.
Duration may vary depending on the organism and clinical course, with treatment continued until infection is fully controlled.
Appointment
Appointments are required in principle. A referral letter from another medical institution is recommended but not mandatory.
For appointment requests and language support, please see the
Cardiovascular Center page.