Treatment of Left-Sided Endocarditis
Antimicrobial Therapy
- The American Heart Association recommends nafcillin or oxacillin for 6 weeks for uncomplicated left-sided native valve endocarditis caused by Methicillin-Susceptible Staphylococcus aureus (MSSA) 1
- The American Heart Association recommends at least 6 weeks of therapy for complicated MSSA infections, such as those with perivalvular abscess or septic metastatic complications 1
- The American Heart Association recommends vancomycin as the treatment for Methicillin-Resistant Staphylococcus aureus (MRSA) 1
- The European Society of Cardiology suggests that early PVE or healthcare-associated IE regimens should cover methicillin-resistant staphylococci, enterococci, and non-HACEK Gram-negative pathogens 3
Surgical Management
- The European Society of Cardiology recommends surgery for aortic or mitral native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) with severe acute regurgitation, obstruction, or fistula causing refractory pulmonary edema or cardiogenic shock (Emergency surgery) 2, 4, 5
- The European Society of Cardiology recommends surgery for aortic or mitral NVE/PVE with severe regurgitation or obstruction causing symptoms of heart failure or echocardiographic signs of poor hemodynamic tolerance (Urgent surgery) 2, 4, 5
- The European Society of Cardiology recommends surgery for locally uncontrolled infection (abscess, false aneurysm, fistula, enlarging vegetation) (Urgent surgery) 2, 4, 5
Outpatient Parenteral Antibiotic Therapy (OPAT)
- The European Society of Cardiology suggests that OPAT can be considered in the continuation phase (beyond week 2) if the patient is medically stable 3, 6
- The European Society of Cardiology recommends against OPAT if the patient has heart failure, concerning echocardiographic features, neurological signs, or renal impairment 3, 6