Perhaps the most alarming event for S aureus is the development of intermediate- and high-level resistance to vancomycin, which was first described in Japan in 1997 8 and subsequently reported in several other areas, including the United States. In addition, reports 5–7 from several areas of the United States indicate that community-acquired infection resulting from ORSA is frequently seen. 2–4 Oxacillin resistance among Staphylococcus aureus (ORSA) isolates is at an all-time high at many tertiary care institutions. Reports from different patient populations indicate that multidrug resistance among viridans group streptococci is now characteristic of many colonizing and infecting strains. Since the most recent version of the American Heart Association (AHA) statement addressing treatment of IE was published in 1995, 1 unparalleled changes have occurred in antibiotic susceptibility among the 3 major bacterial causes of IE: streptococci, staphylococci, and enterococci. Infective endocarditis (IE), like most other syndromes of bacterial infection, has not escaped the impact of burgeoning antibiotic resistance among common pathogens. Streptococcus pneumoniae, Streptococcus pyogenes, and Groups B, C, and G Streptococci…e403Įndocarditis in the Absence of Prosthetic Valves Caused by Staphylococci…e404Įndocarditis in the Presence of Prosthetic Valves or Other Prosthetic Material Caused by Staphylococci…e407Įnterococci Susceptible to Penicillin, Vancomycin, and Aminoglycosides…e408Įnterococci Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin…e410Įnterococci Resistant to Penicillin and Susceptible to Aminoglycosides and Vancomycin…e410Įnterococci Resistant to Penicillin, Aminoglycosides, and Vancomycin…e411 Viridans Group Streptococci and S bovis With Penicillin MIC >0.12 μg/mL to ≤0.5 μg/mL…e403Ībiotrophia defectiva and Granulicatella Species (Formerly Known as Nutritionally Variant Streptococci), Gemella Species, and Viridans Group Streptococci With Penicillin MIC >0.5 μg/mL…e403Įndocarditis of Prosthetic Valves or Other Prosthetic Material Caused by Viridans Group Streptococci and S bovis…e403 Highly Penicillin-Susceptible Viridans Group Streptococci and S bovis (MIC ≤0.12 μg/mL)…e402 Overview of Viridans Group Streptococci, Streptococcus bovis, Abiotrophia defectiva, Granulicatella Species, and Gemella Species…e401 Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.Įchocardiography at Completion of Therapy…e400Īntimicrobial Treatment Perspectives…e400
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To assist physicians who care for children, pediatric dosing was added to each treatment regimen.Ĭonclusions- The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis.
Methods and Results- This work represents the third iteration of an infective endocarditis “treatment” document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.
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