RT Journal Article
T1 Gram-negative endocarditis: disease presentation, diagnosis and treatment
A1 Bouza Santiago, Emilio
A1 Muñoz García, Patricia Carmen
A1 Burillo Albizua, Almudena
AB Este artículo revisa de forma actualizada la endocarditis infecciosa causada por bacilos gramnegativos, una entidad infrecuente pero asociada a elevada morbimortalidad, especialmente cuando está producida por microorganismos no pertenecientes al grupo HACEK. Los autores analizan la epidemiología cambiante de la enfermedad, destacando el aumento de los casos nosocomiales, asociados a procedimientos invasivos, dispositivos intravasculares, pacientes de edad avanzada, inmunodeprimidos y personas que usan drogas por vía parenteral. Se describen las diferencias clínicas, microbiológicas y pronósticas entre la endocarditis por microorganismos HACEK —de evolución más subaguda y mejor pronóstico— y la endocarditis por bacilos gramnegativos no HACEK, caracterizada por mayor agresividad y mortalidad (20–30%). El artículo revisa las dificultades diagnósticas, las opciones terapéuticas actuales, el papel de la terapia combinada con betalactámicos y fluoroquinolonas o aminoglucósidos, la indicación quirúrgica y las limitaciones existentes en el uso de nuevos antimicrobianos frente a patógenos multirresistentes. Se subraya la necesidad de un manejo multidisciplinar experto para optimizar el pronóstico de estos pacientes.Purpose of review            Gram-negative bacilli (GNB) cause between 1% and 10% of infective endocarditis (IE). Most episodes are caused by microorganisms of the Haemophilus spp., Aggregatibacter spp. Cardiobacterium spp., Eikenella spp., and Kingella spp (HACEK) group. The frequency of IE caused by non-HACEK (GNB-IE) has increased in recent years. Uncertainties persist regarding its best medical treatment and the appropriateness and timing of surgical treatment. In addition, there are new drugs with activity against multiresistant microorganisms, of which there is little experience in this disease. We review this topic by answering the most frequently asked questions that arise among our colleagues.                      Recent findings            HACEK microorganisms cause 1.5–2% of IE with only a 2% mortality. In contrast, non-HACEK GNB-IE accounts for 2.5–3% of all IE cases and is associated with nosocomial acquisition, advanced age, solid organ transplantation and 20–30% mortality. Drug addiction is important in areas with epidemic opioid abuse.                      Summary            The frequency of IE caused by GNB has been modified in recent years. HACEK episodes are no longer treated with ampicillin and aminoglycosides. In non-HACEK GNB-IE, combination therapy with a beta-lactam and a quinolone or aminoglycoside is recommended. The surgical indication and its value are evident in many patients. Management should rely on a collaborative group with experience in this disease.
PB Lippincott, Williams & Wilkins
SN 0951-7375
SN 1473-6527
YR 2021
FD 2021-10-19
LK https://hdl.handle.net/20.500.14352/130213
UL https://hdl.handle.net/20.500.14352/130213
LA eng
NO Bouza E, Muñoz P, Burillo A. Gram-negative endocarditis: disease presentation, diagnosis and treatment. Current Opinion in Infectious Diseases 2021;34:672–80. https://doi.org/10.1097/QCO.0000000000000788.
DS Docta Complutense
RD 20 ene 2026