How Is Persistent Bloodstream Infection and Infective Endocarditis Managed?
• Catheter withdrawal is required in the management of catheter-related infective endocarditis (A-II). • TEE should be done for patients with CRBSI who have any of the following: a prosthetic heart valve, pacemaker, or implantable defibrillator; persistent bacteremia or fungemia and/or fever >72 h after initiation of appropriate antibiotic therapy and catheter removal, in addition to a search for metastatic foci of infection, as indicated; and any case of S. aureus CRBSI in which duration of therapy less than 4-6 weeks is being considered (A-II). • Unless the clinical condition of the patient dictates otherwise, perform a TEE at least 5-7 days after the onset of bacteremia or fungemia and consider repeating the TEE for patients with a high index of suspicion for infective endocarditis in whom the initial TEE had negative findings (B-II). • Assess for suppurative thrombophlebitis as noted above (B-II). • Infective endocarditis cannot be ruled out by negative transthoracic echocardiograp
