Medical Management in Adult Patients Following Cardiac Valve Surgery for Infective Endocarditis: A Comprehensive Review.

Despite advances in diagnostic techniques and medical and surgical management, infective endocarditis (IE) poses serious risks of complications including death. Optimal management of IE requires a multidisciplinary IE team, including an infectious disease specialist, cardiologist, and cardiothoracic surgeon, to develop an individualized treatment plan. Cardiac valve surgery plays a crucial role, especially in cases complicated by heart failure, uncontrolled infection, or in the presence of prosthetic devices. Intraoperative collection of valve tissue for microbiologic and histopathologic analysis is important for identification of pathogens. Empiric antimicrobial therapy should be individualized based on patient characteristics and exposures. The standard postoperative intravenous antimicrobial treatment for active IE is typically 4 to 6 weeks, starting from the day of surgery. However, this duration may be adjusted based on factors such as the specific pathogen, its antimicrobial susceptibility, the patient's response to treatment, and pathologic findings. During the initial year following surgery, when the risk of relapse is elevated, it is advisable for patients to be monitored by a heart valve team. Postoperative management of IE should focus on identifying and addressing potential sources of bloodstream infection in high-risk patients, such as dental issues and skin issues. Patients at the highest risk of developing IE or experiencing severe complications are the ones who may benefit from antibiotic prophylaxis.