The AHA Guidelines and Scientific Statements Handbook

Infective Endocarditis

Larry M. Baddour, Kathryn A. Taubert, Michael H. Gewitz, and

Walter R. Wilson

19

Introduction

Guidelines for the diagnosis, antimicrobial therapy,

and management of complications of infective

endocarditis

Diagnosis

Echocardiography

Antimicrobial treatment

Complications and their treatment

Surgical therapy

Congestive heart failure

Risk of embolization

Periannular extension of infection

Mycotic aneurysms

Outpatient therapy

Care at completion of treatment

Short-term follow-up

Long-term follow-up

Guidelines for the prevention of infective endocarditis

History of AHA Statements on prevention of IE

Dental procedures and IE

Cardiac conditions and endocarditis

Prophylaxis for dental procedures in patients with

cardiac conditions associated with the highest risk

of adverse outcome from endocarditis

Regimens for respiratory tract procedures

Recommendations for GI or GU tract procedures

Regimens for procedures on infected skin, skin

structure, or musculoskeletal tissue

Introduction

Two sets of guidelines are reviewed in this chapter

and address infective endocarditis (IE). One guide-

line is dedicated to all aspects of endocarditis diag-

nosis and management and was updated in 2005; the

other examines IE prevention and its latest version

was published in 2007.

The writing groups for both guidelines were

charged with the task of performing an assessment

of the evidence and giving a classifi cation of

recommendations and a level of evidence (LOE) to

each recommendation. The American College of

Cardiology (ACC)/American Heart Association

(AHA) classifi cation system was used in each

document. (See table in the front of the book.)

Guidelines for the diagnosis,

antimicrobial therapy,

and management of complications

of infective endocarditis

This work represents the third iteration of an infec-

tive 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. It updates rec-

ommendations for diagnosis, treatment, and man-

agement of complications 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.

Diagnosis

The variability in clinical presentation of IE requires

a diagnostic strategy that is both sensitive for disease

detection and specifi c for its exclusion across all

forms of the disease. In 1994, Durack and colleagues

from Duke University Medical Center proposed a

diagnostic schema termed the Duke criteria, which

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2