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Aktuelle Therapie der Endokarditis

Neuerungen und Kontroversen

Current treatment of endocarditis

Innovations and controversies

  • Arzneimitteltherapie
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Zusammenfassung

Trotz vieler Fortschritte in der Diagnostik und Therapie ist die Endokarditis weiterhin eine schwerwiegende Erkrankung. Die Epidemiologie hat sich verändert, Staphylokokken haben Streptokokken als die häufigsten Erreger abgelöst, nosokomial erworbene, mit implantierten Fremdkörpern assoziierte oder durch intravenösen Drogengebrauch erworbene Infektionen sind häufiger. Die Inzidenz der Endokarditis hat in den letzten Jahren ständig zugenommen, dabei hat sich das Kollektiv zu zunehmend älteren Patienten mit mehr Komorbiditäten verschoben. Die moderne Behandlung der Endokarditis ist interdisziplinär. Die Pharmakotherapie der Endokarditis richtet sich nach dem Erreger und dessen Empfindlichkeit. Das Vorhandensein einer Kunstklappe oder implantierter Fremdkörper spielt bei der Substanzwahl und der Therapiedauer eine wichtige Rolle. In diesem Beitrag stellen wir die aktuellen therapeutischen Standards dar. Ein besonderer Fokus liegt auf der partiell oralen Therapie und der Rolle der Aminoglykoside.

Abstract

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.

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Literatur

  1. Amat-Santos IJ, Messika-Zeitoun D, Eltchaninoff H et al (2015) Infective Endocarditis after Transcatheter aortic valve implantation. Circulation 131:1566–1574. https://doi.org/10.1161/CIRCULATIONAHA.114.014089

    Article  PubMed  Google Scholar 

  2. Baddour LM, Wilson WR, Bayer AS et al (2015) Infective Endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications. Circulation 132:1435–1486. https://doi.org/10.1161/CIR.0000000000000296

    Article  CAS  PubMed  Google Scholar 

  3. Chuang Y‑C, Lin H‑Y, Chen P‑Y et al (2017) Effect of Daptomycin dose on the outcome of Vancomycin-resistant, Daptomycin-susceptible Enterococcus faecium Bacteremia. Clin Infect Dis 64:1026–1034. https://doi.org/10.1093/cid/cix024

    Article  CAS  PubMed  Google Scholar 

  4. Erba PA, Conti U, Lazzeri E et al (2012) Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med 53:1235–1243. https://doi.org/10.2967/jnumed.111.099424

    Article  CAS  PubMed  Google Scholar 

  5. Fernández-Hidalgo N, Almirante B, Gavaldà J et al (2013) Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis. Clin Infect Dis 56:1261–1268. https://doi.org/10.1093/cid/cit052

    Article  CAS  PubMed  Google Scholar 

  6. Feuchtner GM, Stolzmann P, Dichtl W et al (2009) Multislice computed Tomography in infective Endocarditis. J Am Coll Cardiol 53:436–444. https://doi.org/10.1016/j.jacc.2008.01.077

    Article  PubMed  Google Scholar 

  7. Frantz S, Buerke M, Horstkotte D et al (2016) Kommentar zu den 2015-Leitlinien der Europäischen Gesellschaft für Kardiologie zur Infektiösen Endokarditis. Kardiol 10:142–148. https://doi.org/10.1007/s12181-016-0058-4

    Article  Google Scholar 

  8. Fye WB, Fye BW (1997) Jean François Fernel. Clin Cardiol 20:1037–1038. https://doi.org/10.1002/clc.4960201214

    Article  CAS  PubMed  Google Scholar 

  9. Habib G (2018) Infective Endocarditis after Transcatheter aortic valve replacement: the worst that can happen. J Am Heart Assoc 7:e10287. https://doi.org/10.1161/JAHA.118.010287

    Article  PubMed  PubMed Central  Google Scholar 

  10. Habib G, Badano L, Tribouilloy C et al (2010) Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 11:202–219. https://doi.org/10.1093/ejechocard/jeq004

    Article  PubMed  Google Scholar 

  11. Habib G, Derumeaux G, Avierinos JF et al (1999) Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol 33:2023–2029. https://doi.org/10.1016/s0735-1097(99)00116-3

    Article  CAS  PubMed  Google Scholar 

  12. Habib G, Lancellotti P, Antunes MJ et al (2015) 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J 36:3075–3128. https://doi.org/10.1093/eurheartj/ehv319

    Article  PubMed  Google Scholar 

  13. Iversen K, Ihlemann N, Gill SU et al (2019) Partial oral versus intravenous antibiotic treatment of Endocarditis. N Engl J Med 380:415–424. https://doi.org/10.1056/NEJMoa1808312

    Article  CAS  PubMed  Google Scholar 

  14. Latib A, Naim C, De Bonis M et al (2014) TAVR-associated prosthetic valve infective Endocarditis. J Am Coll Cardiol 64:2176–2178. https://doi.org/10.1016/j.jacc.2014.09.021

    Article  PubMed  Google Scholar 

  15. Li JS, Sexton DJ, Mick N et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638. https://doi.org/10.1086/313753

    Article  CAS  PubMed  Google Scholar 

  16. Loewe L, Rosenblatt P, Greene HJ (1946) Combined penicillin and heparin therapy of subacute bacterial Endocarditis. Bull N Y Acad Med 22:270–272

    PubMed  PubMed Central  Google Scholar 

  17. Mangner N, Woitek F, Haussig S et al (2016) Incidence, predictors, and outcome of patients developing infective Endocarditis following Transfemoral Transcatheter aortic valve replacement. J Am Coll Cardiol 67:2907–2908. https://doi.org/10.1016/j.jacc.2016.03.588

    Article  PubMed  Google Scholar 

  18. Mangner N, Leontyev S, Woitek FJ et al (2018) Cardiac surgery compared with antibiotics only in patients developing infective Endocarditis after Transcatheter aortic valve replacement. J Am Heart Assoc 7:e10027. https://doi.org/10.1161/JAHA.118.010027

    Article  PubMed  PubMed Central  Google Scholar 

  19. Murdoch DR, Corey GR, Hoen B et al (2009) Clinical presentation, etiology, and outcome of infective Endocarditis in the 21st century. Arch Intern Med 169:463. https://doi.org/10.1001/archinternmed.2008.603

    Article  PubMed  PubMed Central  Google Scholar 

  20. Osler W (1885) The Gulstonian lectures, on malignant Endocarditis. BMJ 1:577–579. https://doi.org/10.1136/bmj.1.1264.577

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Peiffer-Smadja N, Abbara S, Rizk N et al (2018) High-dose daptomycin in patients with infective endocarditis or sternal wound infections. Clin Microbiol Infect 24:1106–1108. https://doi.org/10.1016/j.cmi.2018.05.015

    Article  CAS  PubMed  Google Scholar 

  22. Ramos-Martínez A, Muñoz Serrano A, de Alarcón González A et al (2018) Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis. J Infect Chemother 24:555–562. https://doi.org/10.1016/j.jiac.2018.03.003

    Article  CAS  PubMed  Google Scholar 

  23. Regueiro A, Linke A, Latib A et al (2016) Association between Transcatheter aortic valve replacement and subsequent infective Endocarditis and in-hospital death. JAMA 316:1083. https://doi.org/10.1001/jama.2016.12347

    Article  PubMed  Google Scholar 

  24. Saby L, Laas O, Habib G et al (2013) Positron emission Tomography/computed Tomography for diagnosis of prosthetic valve Endocarditis. J Am Coll Cardiol 61:2374–2382. https://doi.org/10.1016/j.jacc.2013.01.092

    Article  PubMed  Google Scholar 

  25. Statistisches Bundesamt (2019) Diagnosedaten der Krankenhäuser ab 2000. http://www.gbe-bund.de

    Google Scholar 

  26. Toyoda N, Chikwe J, Itagaki S et al (2017) Trends in infective Endocarditis in California and New York State, 1998–2013. JAMA 317:1652. https://doi.org/10.1001/jama.2017.4287

    Article  PubMed  PubMed Central  Google Scholar 

  27. Weis S, Kesselmeier M, Davis JS et al (2019) Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect 25:818–827. https://doi.org/10.1016/j.cmi.2019.03.010

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    F. Hitzenbichler, F. Hanses & B. Salzberger

  2. Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Deutschland

    J. Olic, M. Fischer & A. Baessler

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  1. F. Hitzenbichler
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  2. J. Olic
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  5. M. Fischer
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  6. A. Baessler
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Correspondence to F. Hitzenbichler.

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Interessenkonflikt

F. Hitzenbichler: Klinische Studie mit Basilea. Reisekosten und Kongressgebühren: Gilead. F. Hanses: Beratungstätigkeit Correvio. Klinische Studie mit Basilea. B. Salzberger: Beratungstätigkeit für Sanofi und Roche. Klinische Studie mit Basilea. J. Olic, M. Fischer und A. Baessler geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Wehling, Mannheim

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Hitzenbichler, F., Olic, J., Hanses, F. et al. Aktuelle Therapie der Endokarditis. Internist 60, 1111–1117 (2019). https://doi.org/10.1007/s00108-019-00664-4

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