45
Table 31B. Diagnosis and Treatment of IE (cont'd)
Recommendations
COR LOE
TEE & TTE (cont'd)
TEE is recommended in all patients with known or suspected
IE when TTE is nondiagnostic, when complications have
developed or are clinically suspected, or when intracardiac
device leads are present.
I B
TTE and/or TEE are recommended for re-evaluation
of patients with IE who have a change in clinical signs or
symptoms (eg, new murmur, embolism, persistent fever,
HF, abscess, or atrioventricular heart block) and in patients
at high risk of complications (eg, extensive infected tissue/
large vegetation on initial echocardiogram or staphylococcal,
enterococcal, or fungal infections).
I B
Intraoperative TEE is recommended for patients undergoing
valve surgery for IE.
I B
TEE is reasonable to diagnose possible IE in patients with
S. aureus bacteremia without a known source.
IIa B
TEE is reasonable to diagnose IE of a prosthetic valve in
the presence of persistent fever without bacteremia or a
new murmur.
IIa B
TEE might be considered to detect concomitant
staphylococcal IE in nosocomial S. aureus bacteremia with a
known portal of entry from an extracardiac source.
IIb B
Medical erapy
Patients with IE should be evaluated and managed with
consultation of a multispecialty Heart Valve Team including
an infectious disease specialist, cardiologist, and cardiac
surgeon. In surgically managed patients, this team should also
include a cardiac anesthesiologist.
I B
Appropriate antibiotic therapy should be initiated and continued
aer blood cultures are obtained, with guidance from antibiotic
sensitivity data and infectious disease consultants.
I B
It is reasonable to temporarily discontinue anticoagulation
in patients with IE who develop CNS symptoms compatible
with embolism or stroke, regardless of other indications for
anticoagulation.
IIa B
Temporary discontinuation of VKA anticoagulation might
be considered in patients receiving VKA anticoagulation at
the time of IE diagnosis.
IIb B
Patients with known VHD should NOT receive antibiotics
before blood cultures are obtained for unexplained fever.
III: Harm C
