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  • Endocarditis can present with a wide range of signs and symptoms, including fever, chills, fatigue, and heart-related symptoms.
  • Peripheral manifestations, such as Janeway lesions, Osler nodes, and splinter hemorrhages, can provide valuable diagnostic clues.
  • Non-specific symptoms, such as fever and malaise, may be the only presenting features in some cases, emphasizing the importance of clinical vigilance.
  • Case studies can illustrate the recognition and management of endocarditis in various clinical scenarios.
  • The modified Duke criteria, which incorporate clinical, microbiological, and echocardiographic findings, are the basis for diagnosing infective endocarditis.
  • Blood cultures and other laboratory tests are essential components of the diagnostic workup.
  • Serological markers may be helpful in identifying causative organisms in culture-negative endocarditis.
  • Echocardiography, including both TTE and TEE, is a critical imaging modality for the diagnosis and management of IE.
  • The diagnosis of IE can be challenging in certain populations, such as those with prosthetic valves or intracardiac devices.
  • Antimicrobial therapy is the cornerstone of endocarditis treatment, and the choice of antibiotic depends on the causative organism, susceptibility profile, and patient factors.
  • Streptococcal, staphylococcal, and enterococcal endocarditis require different antibiotic regimens, while treatment for Gram-negative bacilli, fungi, and uncommon organisms should be tailored to the specific pathogen.
  • Monitoring susceptibility patterns and resistance trends is essential for guiding therapy.
  • Prolonged courses of therapy are usually necessary, and combination therapy may be required in certain cases.
  • Treatment should be reassessed and adjusted based on clinicalresponse, laboratory data, and follow-up imaging studies.
  • Clinical pharmacists play a critical role in endocarditis management through interdisciplinary collaboration with other healthcare providers.
  • They are responsible for reviewing and optimizing antibiotic regimens, as well as monitoring for adverse effects and drug interactions.
  • Patient education and promoting medication adherence are essential components of the clinical pharmacist’s role.

References

  1. Slipczuk, L., et al. (2013). Infective endocarditis epidemiology over five decades: a systematic review. PLoS One, 8(12), e82665. ↩
  2. Cahill, T. J., & Prendergast, B. D. (2016). Infective endocarditis. The Lancet, 387(10021), 882-893. ↩
  3. Habib, G., et al. (2015). 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). European Heart Journal, 36(44), 3075-3128. ↩
  4. Durack, D. T. (1995). Experimental bacterial endocarditis. IV. Structure and evolution of very early lesions. Journal of Pathology, 115(2), 81-89. ↩
  5. Murdoch, D. R., et al. (2009). Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis–Prospective Cohort Study. Archives of internal medicine, 169(5), 463-473. ↩
  6. Brouqui, P., & Raoult, D. (2010). Endocarditis due to rare and fastidious bacteria. In Infective Endocarditis (pp. 197-219). Springer, New York, NY. ↩
  7. Holland, T. L., et al. (2016). Antibiotic treatment of infective endocarditis. Current Infectious Disease Reports, 18(2), 7. ↩
  8. Que, Y. A., & Moreillon, P. (2011). Infective endocarditis. Nature ReviewsCardiology, 8(6), 322-336. ↩
  9. Nishimura, R. A., et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(22), e57-e185. ↩
  10. Thuny, F., et al. (2012). Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation, 112(1), 69-75. ↩
  11. Evangelista, A., & Gonzalez-Alujas, M. T. (2004). Echocardiography in infective endocarditis. Heart, 90(6), 614-617. ↩
  12. Tleyjeh, I. M., & Steckelberg, J. M. (2007). Risk factors for prosthetic valve infective endocarditis: a population-based case-control study. Clinical Infectious Diseases, 44(12), 1583-1590. ↩
  13. Lockhart, P. B., et al. (2009). Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation, 119(20), 2520-2544.
  14. Durack, D. T., & Lukes, A. S. (1999). Systemic symptoms and signs in infective endocarditis. In Infective Endocarditis (pp. 201-212). Springer, New York, NY. ↩
  15. Sexton, D. J., & Spelman, D. (2018). Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Cardiology Clinics, 36(2), 225-232. ↩
  16. Habib, G., et al. (2015). 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). European Heart Journal, 36(44), 3075-3128. ↩
  17. Kaasch, A. J., & Fowler, V. G. Jr. (2018). Recognizing infective endocarditis in the clinical setting. Cardiology Clinics, 36(2), 215-224. ↩
  18. Durack, D. T. (1995). Infective and noninfective endocarditis. In J. Hurst (Ed.), The Heart (8th ed., pp. 1963-1983). New York: McGraw-Hill. ↩
  19. Cahill, T. J., & Prendergast, B. D. (2016). Infective endocarditis. The Lancet, 387(10021), 882-893. ↩
  20. Mylonakis, E., & Calderwood, S. B. (2001). Infective endocarditis in adults. New England Journal of Medicine, 345(18), 1318-1330. ↩
  21. Math, R. S., et al. (2015). Evaluation of the diagnostic criteria for the Duke classification in 93 episodes of prosthetic valve endocarditis: could sensitivity be improved? Archives of Internal Medicine, 175(3), 345-355. ↩
  22. Li, J. S., et al. (2000). Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clinical Infectious Diseases, 30(4), 633-638. ↩
  23. Durack, D. T., Lukes, A. S., & Bright, D. K. (1994). New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. The American Journal of Medicine, 96(3), 200-209. ↩
  24. Baddour, L. M., et al. (2015). Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 132(15), 1435-1486. ↩
  25. Fournier, P. E., et al. (2001). Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clinical Infectious Diseases, 33(2), 141-146. ↩
  26. Habib, G., et al. (2015). 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). European Heart Journal, 36(44), 3075-3128. ↩
  27. Cahill, T. J., & Prendergast, B. D. (2016). Infective endocarditis. The Lancet, 387(10021), 882-893. ↩
  28. Baddour, L. M., et al. (2015). Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 132(15), 1435-1486. ↩
  29. Holland, T. L., et al. (2016). Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial. JAMA, 316(12), 1271-1280. ↩
  30. Habib, G., et al. (2015). 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). European Heart Journal, 36(44), 3075-3128. ↩
  31. Liu, C., et al. (2011). Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clinical Infectious Diseases, 52(3), e18-e55. ↩
  32. Baddour, L. M., et al. (2015). Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 132(15), 1435-1486. ↩
  33. Chambers, H. F., & Morris, D. L. (1988). Treatment of endocarditis caused by gram-negative bacilli with ceftriaxone and gentamicin. Antimicrobial Agents and Chemotherapy, 32(5), 745-747. ↩
  34. Pappas, P. G., et al. (2016). Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 62(4), e1-e50. ↩
  35. CLSI. (2018). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Eighth Informational Supplement. CLSI document M100-S28. Wayne, PA: Clinical and Laboratory Standards Institute. ↩
  36. Habib, G., et al. (2015). 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). European Heart Journal, 36(44), 3075-3128. ↩
  37. Baddour, L. M., et al. (2015). Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 132(15), 1435-1486. ↩
  38. Holland, T. L., et al. (2016). Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial. JAMA, 316(12), 1271-1280. ↩
  39. McEvoy, G. K., & Litvak, K. (2012). Pharmacy education and practice in 13 middle eastern countries. American Journal of Pharmaceutical Education, 76(10), 1-11. ↩
  40. Baddour, L. M., et al. (2015). Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 132(15), 1435-1486. ↩
  41. Rodvold, K. A., & Pai, M. P. (2011). Pharmacokinetics and pharmacodynamics of anti-infective agents. In L. G. Guglielmo, B. A. B. Jacobs, & J. L. Kradjan (Eds.), Applied therapeutics: The clinical use of drugs (10th ed., pp. 1-39). Lippincott Williams & Wilkins. ↩
  42. O’Leary, R., Osih, R., & Yeung, S. (2018). The Role of the Clinical Pharmacist in the Care of Patients with Cardiovascular Disease. Canadian Journal of Cardiology, 34(11), S251-S257. ↩
  43. Bond, C. A., & Raehl, C. L. (2006). Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy, 26(4), 481-493. ↩