298 Ch 297. Infective Endocarditis (Native Valve)

IE 是 endocardium 感染（多為瓣膜）；分 native valve (NVE) vs prosthetic (PVE, Ch298) vs CIED-related vs IV drug-related vs healthcare-associated；最常見病原：viridans Strep（亞急性 NVE）、Staph aureus（急性，最常見 worldwide）、Enterococcus、HACEK、coagulase-negative Staph、Strep gallolyticus（與 colorectal 癌相關）、Bartonella、Coxiella、Tropheryma whipplei；Duke criteria 改版 2023 (Modified Duke / European Society) 為診斷標準（major: blood cultures + endocardial involvement；minor: predisposition、fever、vascular、immunologic、microbiology）；echo (TTE → TEE) 是首選；新工具：FDG-PET-CT + CT 整合（特別對 prosthetic、CIED）；治療：empiric IV antibiotics → narrow per culture × 4-6 週；indications for surgery：HF、persistent bacteremia despite 7d treatment、refractory infection、severe valvular dysfunction、large vegetation > 10 mm with embolism、abscess、fungal、locally invasive；prophylaxis 2024 ACC/AHA：限制於 highest-risk patients (prosthetic valve, prior IE, unrepaired cyanotic CHD, repair < 6 mo, residual defect adjacent prosthetic, cardiac transplant valvulopathy) + dental procedure with manipulation of gingiva。