Book Review

Infective Endocarditis: Management in the Era of Intravascular Devices

N Engl J Med 2007; 357:1268September 20, 2007

Article

Infective Endocarditis: Management in the Era of Intravascular Devices
(Infectious Disease and Therapy. 41.) Edited by John L. Brusch. 363 pp., illustrated. New York, Informa Healthcare, 2007. $229.95. ISBN: 978-0-8493-7097-7

Infective endocarditis is an uncommon disease that remains important to clinicians in many disciplines because it is uniformly fatal if it is not diagnosed and properly treated. If a timely diagnosis is made and proper treatment is given, many patients can recover fully and return to their previous state of health. Failure to diagnose or correctly treat infective endocarditis remains a vexing problem — one that has not escaped the notice of malpractice attorneys. Furthermore, as the editor of this book, John Brusch, emphasizes in the preface, the increasing problem of resistance to antimicrobial agents and the increasing use of intravascular devices have changed how infective endocarditis is diagnosed and managed in everyday practice.

Brusch edited and wrote 14 of the 17 chapters in this book, the latest installment in the Infectious Disease and Therapy series from Informa Healthcare. Brusch and his mentor, Louis Weinstein, wrote Infective Endocarditis more than a decade ago (New York: Oxford University Press, 1996). This book, an updated version of the original, stresses the increasing importance of prosthetic devices and staphylococci in the clinical management and outcomes of patients with infective endocarditis. Brusch's writing style is clear and concise. The book contains thousands of citations from the extensive literature on the disease. There are, for example, 347 references in a single chapter on the clinical correlates and microbiology of infective endocarditis that is caused by gram-positive organisms. Despite such thoroughness, however, one error is notable. The statement that no synergistic therapy is available for the treatment of infective endocarditis that is caused by enterococci with high-level resistance to aminoglycosides is incorrect. Some patients with this type of the disease can be treated successfully with a combination of ampicillin and ceftriaxone.

The chapters on the pathology, pathogenesis, and clinical features of infective endocarditis are well written and provide excellent historical reviews of the topics. However, no mention is made of the criteria that were recently proposed for separating vegetations from the noninfected inflammatory debris that may be present on the noninfected valves of patients who are undergoing valve surgery. The discussion of the relapse and recurrence of infective endocarditis would have benefited from better and more precise definitions of the terms. In addition, there is no mention of the recent use of propensity analyses to assess the effectiveness of surgery in patients with infective endocarditis.

The chapters on patients with infective endocarditis associated with intracardiac devices and patients with nosocomial and health care–associated infective endocarditis are notable strengths of this book. They are well written and provide comprehensive perspectives on these important problems. Brusch thoroughly understands the broad range of clinical infections that may occur in patients with intravascular and intracardiac devices. His discussion of diagnosing infective endocarditis and options for managing the disease is excellent, with one striking exception. Options for treating patients with infective endocarditis who depend on pacemakers and must have the device removed and replaced are not discussed in sufficient detail.

This book will be of limited use for specialists or generalists who are seeking the latest information on the treatment and management of infective endocarditis, but it will still serve as a reference for specialists who seek a thorough historical review of a specific facet of the broad topic of infective endocarditis. It also will be useful for residents in internal medicine or surgery and fellows in infectious diseases who want a comprehensive review of the clinical and pathological features of infective endocarditis or a general overview of specific types of the disease.

Daniel J. Sexton, M.D.
Duke University Medical Center, Durham, NC 27710