Treatment Criteria for Infectious Endocarditis

Infectious endocarditis is a serious infection that affects the inner lining of the heart chambers and valves. For individuals without a medical background, understanding the criteria for recovery can be simplified into two main categories: non-surgical recovery and surgical recovery.

Non-Surgical Recovery

Non-surgical treatment typically involves a prolonged course of antibiotics lasting 4–6 weeks. A successful outcome is indicated when the patient experiences relief or complete resolution of symptoms, such as fever and fatigue. Clinically, the following signs suggest improvement:

Body temperature returns to normal, and the spleen, which may have been enlarged due to infection, begins to shrink. Blood tests show a gradual increase in red blood cell count and hemoglobin levels. Inflammatory markers such as white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) levels decline and eventually return to normal ranges.

Echocardiography is also a crucial tool in assessing recovery. It can reveal a reduction or complete disappearance of vegetations—abnormal growths on the heart valves caused by infection. Additionally, blood cultures taken at 1 week, 2 weeks, and 6 weeks after discontinuing antibiotics should remain negative, indicating no residual bacterial presence.

Surgical Recovery

Surgical intervention becomes necessary when complications such as valve damage, heart failure, or persistent infection occur. Successful surgical recovery means the patient has regained stable hemodynamics and improved cardiac function.

Post-Operative Evaluation

After surgery, echocardiographic assessments are performed to confirm that the structural issues have been corrected. One week post-operation and after completing antibiotic therapy, the heart valves should function properly without any vegetations or paravalvular leaks.

The criteria for surgical recovery mirror those of non-surgical treatment, including the absence of symptoms, normalized lab values, and negative blood cultures. This combined clinical and laboratory evaluation ensures the infection has been fully eradicated and the heart is functioning optimally.