Endocarditis long term care

Associate Editor-in-Chief:

Overview
Patients should be educated regarding the symptoms of recurrent endocarditis and they should be told to remind future healthcare providers that three blood cultures should be drawn from separate sites before antibiotics are administered. Unfortunately, the administration of antibiotics before obtaining blood cultures is  the predominant cause of (blood) culture negative endocarditis.

==Short-Term Follow-Up ==

Imaging Studies
Prior to completion of their course of antibiotic therapy, patients with endocarditis should have a tranthoracic echo (TTE) performed to establish a baseline for comparison with future studies (Class IIb, Level of Evidence: C).

Drug Counseling
Intravenous drug users should be referred to a drug rehabilitation program. Again, education is critical so that these patients are familar with the symptoms of recurrent endocarditis and they should be urged to seek immediate medical attention should they develop these symptoms.

Dental Evaluation
In order to avoid a recurrence of endocarditis, a dentist should evaluate the patient's oral hygeine, offer counseling, and eradicate any ongoing source of infection.

Prompt Removal of Indwelling Catheters
All indwelling catheters should be removed immediately upon the completion of the antibiotic course to minimize the potential for colonization and recurrent infection.

Long-Term Follow-Up
Months to years after completion of medical therapy for IE, patients need ongoing observation and education regarding recurrent infection and delayed onset of worsening valvular dysfunction. Ongoing daily dental hygiene should be stressed, with serial evaluations by a dentist who is familiar with this patient population.

Patients should be questioned about the symptoms of decreased cardiac output and CHF. A thorough cardiac examination will be needed. Additional evaluations with TTE will be necessary in selected patients with positive findings from history and physical examination. Patients must be reminded to seek immediate medical evaluation for fever. This is necessary because IE can mimic a panoply of febrile illnesses.