Diagnostic approaches in infective endocarditis.

UNLABELLED Infective endocarditis is a true systemic infection and a life-threatening disease associated with high mortality. AIM To evaluate the problems that occur during making the diagnosis of infective endocarditis, in order to highlight the need of other diagnostic prospects. MATERIAL AND METHODS Retrospective study using clinical, microbiological, and echocardiographic findings from 45 patients admitted to the Iasi Infectious Diseases Hospital in the interval January 2007 - January 2011. RESULTS A positive diagnosis of infective endocarditis was made based on Duke Criteria. Inflammatory syndrome revealed leukocytosis with neutrophilia in 42% of the patients. In 91% of the cases fever syndrome was present. Blood cultures were positive in almost 45% of the cases, and the identified etiologic agents were Staphylococcus spp., Streptococcus spp., Achromobacter spp., Klebsiella spp., Enterococcus spp., E. coli. In 95% of the patients, the echocardiographic appearance was a major criterion for diagnosis. Associated diseases were most often present with rebound on the course. Cardiac complications occurred despite treatment and re-evaluations. Ten percent of our cases required transfer to cardiology and cardiac surgery units. CONCLUSIONS Microbiologic diagnosis was mainly based on cultured-dependent methods that often fail because of previous antibiotic therapy or the involvement of fastidious microorganism. In this case, advances in molecular diagnostics have yielded new tools (polymerase chain reaction - PCR techniques) to diagnose this disease.