Endocarditis long term care
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Patients should be educated regarding the symptoms of recurrent endocarditis and they should be told to remind future healthcare providers that three blood cultures should be drawn from separate sites before antibiotics are administered. Unfortunately, the administration of antibiotics before obtaining blood cultures is the predominant cause of (blood) culture negative endocarditis. [1] [2]
Short-Term Follow-Up[1] [2]
Imaging Studies
Prior to completion of their course of antibiotic therapy, patients with endocarditis should have a tranthoracic echo (TTE) performed to establish a baseline for comparison with future studies (Class IIb, Level of Evidence: C).
Drug Counseling
Intravenous drug users should be referred to a drug rehabilitation program. Again, education is critical so that these patients are familar with the symptoms of recurrent endocarditis and they should be urged to seek immediate medical attention should they develop these symptoms.
Dental Evaluation
In order to avoid a recurrence of endocarditis, a dentist should evaluate the patient's oral hygeine, offer counseling, and eradicate any ongoing source of infection.
Prompt Removal of Indwelling Catheters
All indwelling catheters should be removed immediately upon the completion of the antibiotic course to minimize the potential for colonization and recurrent infection.
Long-Term Follow-Up
Months to years after completion of medical therapy for IE, patients need ongoing observation and education regarding recurrent infection and delayed onset of worsening valvular dysfunction. Ongoing daily dental hygiene should be stressed, with serial evaluations by a dentist who is familiar with this patient population.
Patients should be questioned about the symptoms of decreased cardiac output and CHF. A thorough cardiac examination will be needed. Additional evaluations with TTE will be necessary in selected patients with positive findings from history and physical examination. Patients must be reminded to seek immediate medical evaluation for fever. This is necessary because IE can mimic a panoply of febrile illnesses.
References
- ↑ 1.0 1.1 Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A. (2005). "Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.
- ↑ 2.0 2.1 Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2007). "American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 116 (15): 1736–54. PMID 17446442.