The management of infectious diseases is constantly changing as new diagnostic strategies and therapeutic options become available. Clinicians must be aware of the most recent recommendations issued by professional organizations to provide the latest evidence-based highlights recent updates to practice guidelines for three commonly encountered infections: infective endocarditis, hospital-acquired pneumonia, and ventilator-associated pneumonia.
On October 13, 2015, the American Heart Association published updated practice guidelines for the management of infective endocarditis (IE) in adult patients.1
These guidelines are endorsed by the Infectious Diseases Society of America (IDSA) and incorporate recent evidence-based recommendations for the diagnosis and treatment of IE available after the last published iteration in 2005.2
Although the incidence of IE is relatively low (three to ten cases per 100,000 individuals annually), the condition is associated with significant morbidity, mortality, and use of healthcare resources.3,4
The diagnosis of IE remains based on the modified Duke criteria of clinical, pathological, and echocardiographic findings. A minimum of three sets of blood cultures should be drawn from different venipuncture sites over the course of at least one hour.1 Staphylococcus aureus
is the leading causative organism responsible for native and prosthetic valve IE, with both community-acquired and healthcare-associated cases frequently encountered.1,3,5
Transthoracic echocardiography (TTE) should be performed initially in all patients with suspected IE. Transesophageal echocardiography may be necessary if the TTE images are negative or inadequate in patients with a strong suspicion for IE, or if there is a positive TTE and a concern for intracardiac complications.1
The roles of newer imaging modalities, such as three-dimensional echocardiography, computed tomography, and magnetic resonance imaging, have yet to be determined.1,4