50
Infectious Endocarditis
Table 34B. Diagnosis and Treatment of IE (cont'd)
Recommendations
COR LOE
Surgical erapy
Decisions about timing of surgical intervention should be
made by a multispecialty Heart Valve Team of cardiolog y,
cardiothoracic surgery, and infectious disease specialists.
I B
Early surgery
a
is indicated in patients with IE who present
with valve dysfunction resulting in symptoms of HF.
I B
Early surgery
a
is indicated in patients with le-sided IE caused
by S. aureus, fungal, or other highly resistant organisms.
I B
Early surgery
a
is indicated in patients with IE complicated
by heart block, annular or aortic abscess, or destructive
penetrating lesions.
I B
Early surgery
a
for IE is indicated in patients with evidence of
persistent infection as manifested by persistent bacteremia or
fevers lasting longer than 5–7 days aer onset of appropriate
antimicrobial therapy.
I B
Surgery is recommended for patients with prosthetic valve
endocarditis (PVE) and relapsing infection (defined as recurrence
of bacteremia aer a complete course of appropriate antibiotics
and subsequently negative blood cultures) without other
identifiable source for portal of infection.
I C
Complete removal of pacemaker or defibrillator systems,
including all leads and the generator, is indicated as part of the
early management plan in patients with IE with documented
infection of the device or leads.
I B
Complete removal of pacemaker or defibrillator systems,
including all leads and the generator, is reasonable in patients
with valvular IE caused by S. aureus or fungi, even without
evidence of device or lead infection.
IIa B
Complete removal of pacemaker or defibrillator systems,
including all leads and the generator, is reasonable in patients
undergoing valve surgery for valvular IE.
IIa C
Early surgery
a
is reasonable in patients with IE who present
with recurrent emboli and persistent vegetations despite
appropriate antibiotic therapy.
IIa B
Early surgery
a
may be considered in patients with native valve
endocarditis (NVE) who exhibit mobile vegetations >10
mm in length (with or without clinical evidence of embolic
phenomena).
IIb B
Operation without delay may be considered in patients with
IE and an indication for surgery who have suffered a stroke
but have no evidence of intracranial hemorrhage or extensive
neurological damage. (New recommendation for 2017)
IIb B-NR
Delaying valve surgery for ≥4 weeks may be considered for
patients with IE and major ischemic stroke or intracranial
hemorrhage if the patient is hemodynamically stable.
(New recommendation for 2017)
IIb B-NR
a
Early surgery is defined as during initial hospitalization before completion of a full therapeutic
course of antibiotics.
