Infektiöse Endokarditis – Update

Patienten mit infektiöser Endokarditis sind oft multimorbid und in kritischem klinischen Zustand. Der klinische Verlauf der Erkrankung und ihrer Komplikationen erfordern maximale kardiale und extrakardiale Therapiemaßnahmen. Aktuelle Ansätze betreffen dabei die 3 Bausteine Prävention, Diagnostik und Therapie. Im Folgenden werden Neuentwicklungen in den genannten Bereichen detaillierter betrachtet und mögliche klinische Implikationen diskutiert.

Kernaussagen

• Die infektiöse Endokarditis ist eine seltene, aber unverändert lebensbedrohliche Erkrankung mit einer Gesamtmortalität von 20%.

• Es werden 2 klinische Verlaufsformen unterschieden: die Endokarditis der Nativklappen und die Prothesenendokarditis.

• Die Diagnose der Erkrankung orientiert sich neben den klinischen Symptomen einer Infektionserkrankung und mikrobiologischen Verfahren an der Bildgebung, vor allem an der transösophagealen Echokardiografie.

• Extrakardiale Komplikationen können oft zur Verzögerung der Diagnosestellung führen.

• Die Therapie einer infektiösen Endokarditis orientiert sich an 2 Eckpfeilern: der medikamentös antibiotischen Therapie und der kardiochirurgischen Sanierung – häufig ist ein kombiniertes Vorgehen nötig.

• Die kardiochirurgische Therapie strebt eine Wiederherstellung der Klappenfunktionen unter radikaler Entfernung von infiziertem Material an.

• Die Prognose der Erkrankung ist von einer frühzeitigen Diagnosesicherung abhängig.

• Die Festlegung der adäquaten Therapie setzt ein interdisziplinäres Vorgehen voraus.

• Spezielle Risikoscores könnten zur verbesserten individuellen Therapie beitragen.

Schlüsselwörter

infektiöse Endokarditis - Antibiotika - Herzchirurgie

Publication History

Article published online:
01 June 2022

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