Enterococcus faecalis infective endocarditis: focus on clinical aspects

Abstract

Enterococcus faecalis infective endocarditis (IE) is a disease of increasing importance, with more patients infected, increasing frequency of health-care associated infections and increasing incidence of antimicrobial resistances. The typical clinical presentation is a subacute course with fever, malaise and generalized aches, difficult to distinguish from other more common diseases. Of paramount importance is transthoracic- and transesophageal-echocardiography to establish the diagnosis. At the moment, the predominant strategies recommend ampicillin in combination with either gentamicin or ceftriaxone. E. faecalis infective endocarditis continues to be a very serious disease with considerable percentages of high-level gentamicin resistant strains and in-hospital mortality around 20%. Strategies to prevent E. faecalis IE, improve diagnostics, optimize treatment and reduce morbidity will be necessary to improve the overall prognosis.

Keywords::

• ampicillin
• antibiotic resistance
• ceftriaxone
• enterococcus facalis
• gentamicin
• health care associated
• infective endocarditis
• mortality
• relapse
• treatment

Financial & competing interests disclosure

The below mention book belong to Complex category , we need of additional price for this particular bookThe authors were supported by The Danish Heart Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • The typical port of entry for Enterococcus faecalis causing infective endocarditis (IE) is infections and/or diagnostic or therapeutic procedures in the urinary or gastrointestinal tract.

• • The most frequent findings in E. faecalis IE are fever, malaise and murmurs of the heart.

• • Anemia due to chronic disease is common in patients with E. faecalis IE.

• • White blood cell count can be normal in these patients and therefore normal values can not rule out E. faecalis IE.

• • Echocardiography is of crucial importance in diagnosing E. faecalis IE

• • Guidelines recommend treatment for E. faecalis IE with intravenously penicillin or ampicillin in combination with gentamicin for 4–6 weeks. However, 2 weeks gentamicin might be preferable.

• • For E. faecalis with high-level aminoglycoside resistance, the preferred treatment is 4–6 weeks ampicillin in combination with ceftriaxone. E. faecalis IE continues to be a serious disease with an in-hospital mortality of 21% (7–48%).

• • Healthcare-associated E. faecalis endocarditis is quite common and accounts for approximately 30% of the cases.

Notes