Surgery required for optimal outcome

• Moderate to severe CHF due to valve dysfunction

• Partially dehisced unstable prosthetic valve

• Persistent bacteremia despite optimal antimicrobial therapy

• Lack of effective microbicidal therapy (e.g., fungal or Brucella endocarditis)

• S. aureus PVE with an intracardiac complication

• Relapse of PVE after optimal antimicrobial therapy

Surgery to be strongly considered for improved outcome^a

• Perivalvular extension of infection

• Poorly responsive S. aureus endocarditis involving the aortic or mitral valve

• Large (>10-mm diameter) hypermobile vegetations with increased risk of embolism

• Persistent unexplained fever (≥10 days) in culture-negative NVE

• Poorly responsive or relapsed endocarditis due to highly antibiotic-resistant enterococci or gram-negative bacilli

^aSurgery must be carefully considered; findings are often combined with other indications to prompt surgery.

Note: CHF, congestive heart failure; NVE, native valve endocarditis; PVE, prosthetic valve endocarditis.

Chapter:
Infective Endocarditis