Management of infective endocarditis in the immunocompromised patient

Abstract

Introduction. Infective endocarditis (IE) represents a major public health challenge. The incidence of IE is 13.8 cases per 100,000 population, causing 66,300 deaths globally each year. Among immunocompromised patients, particularly those with HIV/AIDS, the incidence of IE is increasing. Objective(s). of the study: To evaluate, manage, and address the complex treatment of immunocompromised patients (HIV-infected) with complicated IE and multiple comorbidities. Materials and methods. A 45-year-old patient with HIV/AIDS, an IVDU, was evaluated while in critical condition, presenting with fever, hemoptysis, tachycardia, and chest pain. A diagnosis of IE, septic pulmonary embolism, sepsis, and septic anemia was established. The patient was investigated using ECG, ECHO, radiography, CT, and laboratory tests. Results. Initially, a dual antibiotic therapy with amikacin and meropenem was administered according to the antibiogram. Subsequently, on the seventh day of treatment, due to an increase in leukocyte count and ESR, the antibiotic therapy was adjusted, and gentamicin and vancomycin were added to the treatment. Concurrently, analgesics, iron supplements, beta-blockers, and anticoagulants were administered. Under this treatment, the patient's condition improved. The patient was evaluated and monitored dynamically. On the 19th day of treatment, with a positive progression, the patient was discharged with the recommendation to continue antibiotic therapy in tablet form. Conclusion(s). Immunocompromised patients who are intravenous drug users are at high risk for infective endocarditis. They require dynamic evaluation and monitoring. A complex treatment approach and patient compliance are key elements for a better prognosis and patient recovery.