Zusammenfassung
Die infektiöse Endokarditis (IE) ist eine schwerwiegende Erkrankung, die im klinischen Alltag häufig erst mit einer erheblichen Latenz diagnostiziert wird. Nicht zuletzt deshalb ist das Mortalitätsrisiko hoch. Nach Diagnosestellung ist die zeitnahe Einleitung einer antibiotischen Therapie von herausragender Bedeutung. Epidemiologische Verschiebungen im Altersprofil, neue Risikofaktoren und die zunehmende Verwendung intravasaler prothetischer Materialien haben zu Veränderungen des Keimspektrums und des klinischen Bilds geführt, denen neue diagnostische und therapeutische Bemühungen Rechnung tragen müssen. Die in der Regel unspezifischen initialen Symptome wie auch die zunehmende Zahl nosokomialer Endokarditiden erfordern eine hohe diagnostische Kompetenz der behandelnden Ärzte. Hilfestellung bieten verschiedene diagnostische Algorithmen wie auch leitliniengestützte Empfehlungen zur antibiotischen Therapie. Bereits frühzeitig sollte ein Herzchirurg in die Behandlung einbezogen werden, da etwa in der Hälfte aller Erkrankungsfälle eine alleinige antibiotisch-konservative Therapie zu keiner Sanierung der Infektion führt. Bei Eintreten von Komplikationen sollte zeitig eine operative Therapie angestrebt werden. Nach überstandener Endokarditis haben die Patienten zeitlebens ein erhöhtes Risiko für eine erneute Endokarditis. Diesem Umstand wird in den neuen überarbeiteten Empfehlungen zur Prophylaxe der IE der Europäischen Gesellschaft für Kardiologie besonderes Gewicht verliehen.
Abstract
Infective endocarditis is a serious disease that is often diagnosed with a considerable delay in clinical practice and therefore has a high mortality rate; therefore, early diagnosis and antibiotic treatment are extremely important. Epidemiological shifts in the age profile, new risk factors and the increasing use of intravascular prosthetic materials have led to changes in the microbial spectrum and clinical symptoms, which must be taken into account in the diagnostic efforts and therapy. Nonspecific symptoms and the increase in nosocomial endocarditis, especially in critically ill and immunocompromised patients require a high level of diagnostic expertise. With diagnostic algorithms based on guideline recommendations antibiotic treatment has to be initiated as early as possible. For patients with severe infective endocarditis a cardiac surgeon has to be involved from an early stage of the disease as in about 50 % of cases conservative antibiotic therapy alone does not alleviate the infection. Also early surgical treatment should be sought with the onset of complications. After effective treatment and patient survival there will always be an increased risk of suffering from renewed endocarditis. This is taken into account in the new recommendations of the European Society of Cardiology for the prevention of infective endocarditis.
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Dietz, S., Lemm, H., Bushnaq, H. et al. Infektiöse Endokarditis. Internist 54, 51–62 (2013). https://doi.org/10.1007/s00108-012-3090-x
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DOI: https://doi.org/10.1007/s00108-012-3090-x