The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press66010.17650/1818-8338-2025-19-2-K742LECTIONЛЕКЦИЯAntibacterial therapy for infective endocarditis: сurrent approaches and prospectsАнтибактериальная терапия инфекционного эндокардита: современные направления и перспективыhttps://orcid.org/0000-0002-7410-9784KlimenkoA. A.КлименкоА. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia; 8 Leninskiy Prospekt, Moscow 117049, Russia

Россия, 117513 Москва, ул. Островитянова, 1; Россия, 119049 Москва, Ленинский пр-т, 8

https://orcid.org/0009-0007-4140-6276ZainutdinovaE. O.ЗайнутдиноваЕ. О.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117513 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-6462-0899AnishchenkoM. O.АнищенкоМ. О.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117513 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-6890-8777DemidovaN. A.ДемидоваН. А.
Russian Federation

Natalia Aleksandrovna Demidova

1 Ostrovityanova St., Moscow 117997, Russia; 8 Leninskiy Prospekt, Moscow 117049, Russia

Наталья Александровна Демидова

Россия, 117513 Москва, ул. Островитянова, 1; Россия, 119049 Москва, Ленинский пр-т, 8

 

ndemidova03@gmail.comhttps://orcid.org/0000-0001-5675-9487MoritsV.МорицВ.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117513 Москва, ул. Островитянова, 1

https://orcid.org/0000-0002-2083-0437ChipiginaN. S.ЧипигинаН. С.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117513 Москва, ул. Островитянова, 1

N.I. Pirogov National Research Medical University, Ministry of Health of RussiaФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииN.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare DepartmentГБУЗ г. Москвы «Городская клиническая больница №1 им. Н.И. Пирогова Департамента здравоохранения г. Москвы»1504202519247600409202504092025Copyright ©; 2025, Klimenko A.A., Zainutdinova E.O., Anishchenko M.O., Demidova N.A., Morits V., Chipigina N.S.Copyright ©; 2025, Клименко А.А., Зайнутдинова Е.О., Анищенко М.О., Демидова Н.А., Мориц В., Чипигина Н.С.2025Klimenko A.A., Zainutdinova E.O., Anishchenko M.O., Demidova N.A., Morits V., Chipigina N.S.Клименко А.А., Зайнутдинова Е.О., Анищенко М.О., Демидова Н.А., Мориц В., Чипигина Н.С.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/660

Despite the progress in treatment approaches, infective endocarditis remains a severe life-threatening disease with high mortality rate. Growing antibiotic resistance, as well as the ability of microorganisms to form biofilms, complicate the treatment of this disease. The available guidelines emphasize the need for early initiation of empirical antibiotic therapy immediately after blood sampling for bacteria culture test, followed by correction depending on the sensitivity of microorganisms. Combinations of intravenous broad-spectrum bactericidal antibiotics effective against bacteria in biofilms are used. The issue of switching from intravenous forms of antibiotics to outpatient oral therapy is actively discussed in literature. The key problems in treatment of infective endocarditis at the present stage are the tolerance of microorganisms capable of forming biofilms to ongoing treatment and the growth of antibiotic resistance. Improved microbiological diagnostics, introduction of new therapeutic strategies, and compliance with clinical guidelines are necessary to improve outcomes of infective endocarditis. Individual characteristics of the patient, characteristics of the pathogen, and possible risk factors should be taken into account. The combined effect of antibacterial drugs, both “traditional” and “new”, as well as the use of drugs that do not belong to the antibacterial group, may significantly increase survival and reduce the number of complications in patients with infective endocarditis.

Инфекционный эндокардит, несмотря на прогресс в подходах к терапии, остается тяжелым жизнеугрожающим заболеванием с высоким уровнем летальности. Рост резистентности к антибиотикам, а также способность микроорганизмов формировать биопленки осложняют лечение болезни. Имеющиеся рекомендации подчеркивают необходимость раннего начала эмпирической антибактериальной терапии сразу после взятия крови на бактериологическое исследование с последующей коррекцией в зависимости от выявленной чувствительности микроорганизмов. Применяются комбинации внутривенных форм бактерицидных антибиотиков широкого спектра действия, эффективных в отношении бактерий в составе биопленок. В литературе активно обсуждается вопрос перехода от внутривенных форм антибактериальных препаратов к амбулаторной пероральной антибактериальной терапии. Ключевые проблемы в лечении инфекционного эндокардита на современном этапе – толерантность микроорганизмов, способных образовывать биопленки, к проводимому лечению и рост антибиотикорезистентности. Для улучшения исходов инфекционного эндокардита необходимы совершенствование микробиологической диагностики, внедрение новых терапевтических стратегий и соблюдение клинических рекомендаций. Следует учитывать индивидуальные характеристики пациента, особенности возбудителя, имеющиеся факторы риска. Совокупное действие антибактериальных препаратов, как «традиционных», так и «новых», а также применение препаратов, не относящихся к группе антибактериальных, возможно позволят значительно увеличить выживаемость и уменьшить количество осложнений у пациентов с инфекционным эндокардитом.

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