Managing infective endocarditis in the elderly: new issues for an old disease

Figures & data

Table 1 Adaptation and alternatives to 2015 guidelines on Ie suggested according to elder’s comorbidities and functional status^10,11

	Guidelines	Suggested in elderly
Transesophageal echography	In all cases except negative TTE and low clinical suspicion	In case of major confusion and agitation exposing to excess risk of the procedure, consider only repeated TTE in patients contraindicated to surgery
Aminoglycosides	Combined to penicillin A or G or vancomycin in case of streptococcal or enterococcal or staphylococcal endocarditis as stated	Consider aminoglycoside free regimens to avoid renal toxicity
Vancomycin	First-line therapy in β-lactam allergic patients or in case of MRSA	Consider daptomycin to avoid renal toxicity
Therapeutic drug monitoring	Only for vancomycin and aminoglycosides	Consider also for all β-lactams to avoid overdose and underdose adverse effects (neurological toxicity) and inefficacy, respectively
Intravenous therapy	Throughout the antibiotic therapy in all cases	Consider oral or subcutaneous route for antibiotic therapy if infection is under control and in case of poor venous access and/or agitation
Outpatient parenteral therapy	Only in reliable and compliant patients living close to the hospital	Consider in patients for whom the hospital stay is the most deleterious regarding their functional and cognitive decline, especially for elderly living in long-term care facilities

Note: Data from Habib et al¹⁰ and Baddour et al.¹¹

Abbreviations: IE, infective endocarditis; MRSA, methicillin-resistant Staphylococcus aureus; TTE, Trans-thoracic echocardiography.

Table 2 Characteristics of risk scores predicting mortality or morbidity after cardiac surgery

	STS-PROMM^Citation68	Bernstein and Parsonnet^Citation69	Euroscore II^Citation67	STS-IE^Citation65	De Feo^Citation66
Specific to IE	No	No	No	Yes	Yes
Prediction of morbidity after surgery	Yes	No	No	Yes	No
Number of variables included	34	37	17	13	6
Variables included
• Age	X	X	X	X	X
• Other demographic data	X	X	X	X
• Renal failure	X	X	X	X	X
• Other extracardiac chronic diseases	X	X	X	X
• Previous cardiac disease	X	X	X	X
• Cardiac failure/cardiogenic shock at the time of surgery	X	X	X	X	X
• Ventilatory support at the time of surgery	X	X	X	X	X
• Previous cardiac surgery	X	X	X	X
• Elective/urgent surgery	X	X	X	X
• Presence of IE		X			NA
• Positive blood culture					X
• Perivalvular abcess					X

Abbreviations: IE, infective endocarditis; STS-PROMM, Society of Thoracic Surgeons Predicted Risk of Mortality or Major Morbidity; N/A, not applicable; STS-IE, Society of Thoracic Surgeons-Infective Endocarditis.

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