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Der Internist

, 49:34 | Cite as

Diagnostik und Therapie der mikrobiell verursachten Endokarditis

  • D. Horstkotte
  • C. Piper
Schwerpunkt

Zusammenfassung

Der Verdacht einer mikrobiell verursachten Endokarditis stellt hohe diagnostische Anforderungen, da zumindest zu Erkrankungsbeginn keine wegweisenden Symptome/Befunde vorliegen, die Prognose durch Verzögerungen der Diagnostik und damit der sachgerechten Therapie aber nachhaltig negativ beeinflusst wird. Deshalb ist trotz niedriger Prävalenz der Erkrankung bei Patienten mit Fieber zweifelhafter Ätiologie, Septikämien, Klappeninsuffizienzgeräuschen oder hoher Prädisposition, eine Endokarditis differenzialdiagnostisch zu erwägen und unverzüglich eine Echokardiographie durch einen erfahrenen Untersucher zu veranlassen. Diagnostik, medikamentöse und chirurgische Therapie folgen evidenzbasierten Leitlinien, wobei dem Nachweis der ursächlichen Erreger große Bedeutung zukommt. Die antimikrobielle Therapie erfolgt aufgrund der Empfindlichkeitsprüfung im quantitativen Reihenverdünnungstest (Bestimmung der minimalen Hemmkonzentration). Bei Problemen bezüglich der Diagnosesicherung und/oder bei komplizierten Krankheitsverläufen sollte ein Zentrum mit entsprechender Expertise in Anspruch genommen werden.

Schlüsselwörter

Endokarditis Blutkulturen Transösophageale Echokardiographie Antibiotika Akute Klappeninsuffizienz 

Diagnosis and treatment of infective endocarditis

Abstract

In infective endocarditis (IE) initial symptoms and clinical findings are unspecific. It is thus of the utmost importance that physicians primarily involved consider IE a potential diagnosis. Any delay in diagnosis and thus in adequate antimicrobial therapy has a significant negative prognostic influence. Any subject suspected of having IE should immediately have a transthoracic echocardiography (TTE) by an experienced examiner. If the TTE results are inconclusive, transoesophageal echocardiography (TEE) has to be performed without delay. Other steps in diagnosis, medical and surgical therapy follow established and evidence-based guidelines. Antimicrobial regimens are standardized for IE, for which demonstration of causative microorganisms from blood cultures or other microbiological sources are unavoidable. If there are problems in diagnosis, if difficult-to-treat microorganisms are isolated or difficult-to-treat situations (e.g. locally uncontrolled infections) complicate active IE, a reference centre should be involved.

Keywords

Endocarditis Blood cultures Transoesophageal echocardiography Antibiotics Acute valve incompetence 

Notes

Interessenkonflikt

Keine Angaben.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Kardiologische KlinikHerz- und Diabeteszentrum Nordrhein-Westfalen,Ruhr-Universität BochumBad OeynhausenDeutschland

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