Infective Endocarditis

Infective endocarditis (IE) is infection of the endocardial surface, usually a heart valve. Endothelial injury permits a platelet-fibrin thrombus to form; during bacteremia, organisms adhere to it and become embedded in a vegetation that partially shields them from immune defenses and antibiotic penetration. That single lesion creates three linked dangers: valve destruction can produce acute regurgitation and heart failure, friable material can embolize to the brain or other organs, and extension into surrounding tissue can cause abscess and new conduction block. A nurse should connect persistent fever with the patient’s risk factors, blood-culture results, murmur, perfusion, neurologic status, and heart-failure findings rather than waiting for classic skin or eye lesions. Those peripheral stigmata are now uncommon, and their absence does not rule out IE. In a hemodynamically stable patient with suspected IE, obtain at least three blood-culture sets from separate venipuncture sites before antibiotics. In sepsis or septic shock, cultures should be collected promptly, but antimicrobial treatment must not be delayed while trying to complete the collection.