Infective Endocarditis: Management in the Era of Intravascular Devices PDF

Preface

My experience with infective endocarditis extends back to my third year in medical school when I was assigned to present a case on endocarditis on teaching rounds to Dr. Louis Weinstein the next day. To prepare, I read Dr. Weinstein's three-part New England Journal of Medicine article, "Infective Endocarditis in the Antibiotic Era." Because of the lateness of the hour and the encyclopedic nature of Dr. Weinstein's review, the only thing I was able to comprehend was that I, a third-year medical student, was presenting to a world's expert on the subject. This unnerved me to the point that when I opened my mouth really nothing came out. Dr. Weinstein calmed me down and I managed to get through the presentation. Despite this less than auspicious beginning, I persevered in learning as much as I could about endocarditis. I became one of Dr. Weinstein's fellows. In the early 1990s, he asked me to co-author a text on infective endocarditis. It was a wonderful opportunity. I had access to his case files, library, and his unique experience. His generation was the one that saw the disease before and after the advent of anti biotics. Our book (Infective Endocarditis, Oxford University Press, 1996) presented the disease from its first recognition through the onset of AIDS.

This new volume covers the recent profile of this disease. Classic subacute valvular infections still exist. However, Staphylococcus aureus and coagulase- negative staphylococci have become the prominent pathogens. They have assumed this prominence not simply because of their increasing resistance to antimicrobial agents. The major reason for the increasing involvement of the staphylococci in valvular infections is the proliferation of intravascular devices.

This realization inspired the title, Management of Infective Endocarditis in the Era of Intravascular Devices. Subacute disease is thoroughly presented. However, the dominant theme throughout this book is the ability of the staphylococci and other bacteria to infect prosthetic material. I have attempted to cover this topic from the perspective of the pathogenic properties of the organisms as well as of the defects in the defenses of the hosts who require these intravascular devices.

Because of the specialized nature of many of the areas to be covered, I called upon Drs. Cunha, Picard, Jassal, and Kradin to contribute their extensive knowledge and experience to the book. I am deeply grateful for their efforts.