Antimicrobial therapy of native valve endocarditis
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Issues related to the antimicrobial therapy of native valve infective endocarditis (IE) will be reviewed here; the content reflects American, British, and European guidelines [1-3]. The pathogenesis of vegetation formation, complications of IE, and indications for surgery are discussed separately. (See "Pathogenesis of vegetation formation in infective endocarditis" and "Complications and outcome of infective endocarditis" and "Surgery for left-sided native valve endocarditis" and "Infective endocarditis in injection drug users", section on 'Surgery'.)
Issues related to management of prosthetic valve IE and infection associated with cardiac devices are discussed separately. (See "Antimicrobial therapy of prosthetic valve endocarditis" and "Surgery for prosthetic valve endocarditis" and "Infections involving cardiac implantable electronic devices".)
Bactericidal agents are necessary for effective treatment of endocarditis. Therefore, antimicrobial therapy should be dosed to optimize sustained bactericidal serum concentrations throughout as much of the dosing interval as possible. In vitro determination of the minimum inhibitory concentration should be performed routinely.
Empiric therapy — In general, therapy for infective endocarditis (IE) should be targeted to the organism isolated from blood cultures; cultures are positive in over 90 percent of patients with IE. For patients with suspected IE who present without acute symptoms, empiric therapy is not always necessary, and therapy can await blood culture results. Results of blood cultures are usually available within one to three days, and an accurate diagnosis is a critical first step in designing a management strategy. (See "Clinical manifestations and evaluation of adults with suspected native valve endocarditis".)
For acutely ill patients with signs and symptoms strongly suggestive of IE, empiric therapy may be necessary. Such empiric therapy should be administered ONLY after at least two (preferably three) sets of blood cultures have been obtained from separate venipunctures and ideally spaced over 30 to 60 minutes.
- Habib G, Lancellotti P, Antunes MJ, et al. 2015 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.
- Gould FK, Denning DW, Elliott TS, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2012; 67:269.
- Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435.
- Karchmer AW, Moellering RC Jr, Maki DG, Swartz MN. Single-antibiotic therapy for streptococcal endocarditis. JAMA 1979; 241:1801.
- Durack DT, Beeson PB. Experimental bacterial endocarditis. II. Survival of a bacteria in endocardial vegetations. Br J Exp Pathol 1972; 53:50.
- Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis 2004; 38:1651.
- Clinical Laboratory Standards Institute. Performance Standards for Susceptibility Testing. Twenty-second informational supplement CLSI document M100-S22, vol 32. Wayne, PA 2012.
- Aronin SI, Mukherjee SK, West JC, Cooney EL. Review of pneumococcal endocarditis in adults in the penicillin era. Clin Infect Dis 1998; 26:165.
- Baddour LM. Infective endocarditis caused by beta-hemolytic streptococci. The Infectious Diseases Society of America's Emerging Infections Network. Clin Infect Dis 1998; 26:66.
- Lefort A, Mainardi JL, Selton-Suty C, et al. Streptococcus pneumoniae endocarditis in adults. A multicenter study in France in the era of penicillin resistance (1991-1998). The Pneumococcal Endocarditis Study Group. Medicine (Baltimore) 2000; 79:327.
- Fontana R, Canepari P, Lleò MM, Satta G. Mechanisms of resistance of enterococci to beta-lactam antibiotics. Eur J Clin Microbiol Infect Dis 1990; 9:103.
- Murray BE. Beta-lactamase-producing enterococci. Antimicrob Agents Chemother 1992; 36:2355.
- Anderson DJ, Murdoch DR, Sexton DJ, et al. Risk factors for infective endocarditis in patients with enterococcal bacteremia: a case-control study. Infection 2004; 32:72.
- Dahl A, Rasmussen RV, Bundgaard H, et al. Enterococcus faecalis infective endocarditis: a pilot study of the relationship between duration of gentamicin treatment and outcome. Circulation 2013; 127:1810.
- Wilson WR, Wilkowske CJ, Wright AJ, et al. Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis. Ann Intern Med 1984; 100:816.
- Stevens MP, Edmond MB. Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature. Clin Infect Dis 2005; 41:1134.
- Babcock HM, Ritchie DJ, Christiansen E, et al. Successful treatment of vancomycin-resistant Enterococcus endocarditis with oral linezolid. Clin Infect Dis 2001; 32:1373.
- Zimmer SM, Caliendo AM, Thigpen MC, Somani J. Failure of linezolid treatment for enterococcal endocarditis. Clin Infect Dis 2003; 37:e29.
- Britt NS, Potter EM, Patel N, Steed ME. Comparison of the Effectiveness and Safety of Linezolid and Daptomycin in Vancomycin-Resistant Enterococcal Bloodstream Infection: A National Cohort Study of Veterans Affairs Patients. Clin Infect Dis 2015; 61:871.
- Gavaldà J, Len O, Miró JM, et al. Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone. Ann Intern Med 2007; 146:574.
- Fernández-Hidalgo N, Almirante B, Gavaldà J, et al. Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis. Clin Infect Dis 2013; 56:1261.
- Gavaldà J, Torres C, Tenorio C, et al. Efficacy of ampicillin plus ceftriaxone in treatment of experimental endocarditis due to Enterococcus faecalis strains highly resistant to aminoglycosides. Antimicrob Agents Chemother 1999; 43:639.
- McKinnell JA, Arias CA. Editorial Commentary: Linezolid vs Daptomycin for Vancomycin-Resistant Enterococci: The Evidence Gap Between Trials and Clinical Experience. Clin Infect Dis 2015; 61:879.
- Leclercq R, Bingen E, Su QH, et al. Effects of combinations of beta-lactams, daptomycin, gentamicin, and glycopeptides against glycopeptide-resistant enterococci. Antimicrob Agents Chemother 1991; 35:92.
- Caron F, Kitzis MD, Gutmann L, et al. Daptomycin or teicoplanin in combination with gentamicin for treatment of experimental endocarditis due to a highly glycopeptide-resistant isolate of Enterococcus faecium. Antimicrob Agents Chemother 1992; 36:2611.
- Korzeniowski O, Sande MA. Combination antimicrobial therapy for Staphylococcus aureus endocarditis in patients addicted to parenteral drugs and in nonaddicts: A prospective study. Ann Intern Med 1982; 97:496.
- Fowler VG Jr, Boucher HW, Corey GR, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med 2006; 355:653.
- Cosgrove SE, Vigliani GA, Fowler VG Jr, et al. Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic. Clin Infect Dis 2009; 48:713.
- DiNubile MJ. Short-course antibiotic therapy for right-sided endocarditis caused by Staphylococcus aureus in injection drug users. Ann Intern Med 1994; 121:873.
- Chambers HF, Miller RT, Newman MD. Right-sided Staphylococcus aureus endocarditis in intravenous drug abusers: two-week combination therapy. Ann Intern Med 1988; 109:619.
- Ribera E, Gómez-Jimenez J, Cortes E, et al. Effectiveness of cloxacillin with and without gentamicin in short-term therapy for right-sided Staphylococcus aureus endocarditis. A randomized, controlled trial. Ann Intern Med 1996; 125:969.
- Bryant RE, Alford RH. Unsuccessful treatment of staphylococcal endocarditis with cefazolin. JAMA 1977; 237:569.
- Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.
- Sander A, Beiderlinden M, Schmid EN, Peters J. Clinical experience with quinupristin-dalfopristin as rescue treatment of critically ill patients infected with methicillin-resistant staphylococci. Intensive Care Med 2002; 28:1157.
- Moise PA, Schentag JJ. Vancomycin treatment failures in Staphylococcus aureus lower respiratory tract infections. Int J Antimicrob Agents 2000; 16 Suppl 1:S31.
- Moise-Broder PA, Sakoulas G, Eliopoulos GM, et al. Accessory gene regulator group II polymorphism in methicillin-resistant Staphylococcus aureus is predictive of failure of vancomycin therapy. Clin Infect Dis 2004; 38:1700.
- Carugati M, Bayer AS, Miró JM, et al. High-dose daptomycin therapy for left-sided infective endocarditis: a prospective study from the international collaboration on endocarditis. Antimicrob Agents Chemother 2013; 57:6213.
- Batard E, Jacqueline C, Boutoille D, et al. Combination of quinupristin-dalfopristin and gentamicin against methicillin-resistant Staphylococcus aureus: experimental rabbit endocarditis study. Antimicrob Agents Chemother 2002; 46:2174.
- Dailey CF, Dileto-Fang CL, Buchanan LV, et al. Efficacy of linezolid in treatment of experimental endocarditis caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2001; 45:2304.
- Ruiz ME, Guerrero IC, Tuazon CU. Endocarditis caused by methicillin-resistant Staphylococcus aureus: treatment failure with linezolid. Clin Infect Dis 2002; 35:1018.
- Pistella E, Campanile F, Bongiorno D, et al. Successful treatment of disseminated cerebritis complicating methicillin-resistant Staphylococcus aureus Endocarditis unresponsive to vancomycin therapy with linezolid. Scand J Infect Dis 2004; 36:222.
- Andrade-Baiocchi S, Tognim MC, Baiocchi OC, Sader HS. Endocarditis due to glycopeptide-intermediate Staphylococcus aureus: case report and strain characterization. Diagn Microbiol Infect Dis 2003; 45:149.
- Howden BP, Ward PB, Charles PG, et al. Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility. Clin Infect Dis 2004; 38:521.
- Sakoulas G, Eliopoulos GM, Alder J, Eliopoulos CT. Efficacy of daptomycin in experimental endocarditis due to methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2003; 47:1714.
- Morpeth S, Murdoch D, Cabell CH, et al. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med 2007; 147:829.
- GENERAL CONSIDERATIONS
- Empiric therapy
- Clinical response to initial therapy
- Duration of therapy
- Completing therapy
- Follow up
- VIRIDANS STREPTOCOCCI AND STREPTOCOCCUS BOVIS
- OTHER STREPTOCOCCAL SPECIES
- Susceptible strains
- Gentamicin-resistant strains
- High-level penicillin resistance
- High-level aminoglycoside or vancomycin resistance
- Methicillin susceptible
- - Penicillin allergy
- - Uncomplicated right sided
- Methicillin resistant
- Coagulase-negative staphylococci
- HACEK ORGANISMS
- OTHER GRAM-NEGATIVE ORGANISMS
- CULTURE-NEGATIVE ENDOCARDITIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS