Treatment of Spleen Abscess in Infective Endocarditis with Cardiac Valve Involvement

When spleen abscess develops in the setting of infective endocarditis (IE) with cardiac valve involvement, management must account for the complex interplay between the splenic infection and the haemodynamic risk posed by the underlying valvular disease. This specific combination calls for a coordinated, multidisciplinary approach.

Clinical scenario

This protocol applies to patients with spleen abscess occurring in the context of infective endocarditis with cardiac valve involvement. The presence of valve disease in IE significantly shapes both the urgency and the choice of intervention for the splenic focus, requiring close collaboration with Cardiovascular Surgery before any definitive procedure is undertaken.

Treatment approach (summary only)

Management involves extended-term antibiotic therapy — guided by blood cultures and, where feasible, cultures from the abscess itself, with treatment reviewed according to antibiogram results. The choice of surgical or interventional approach to the spleen is made in cooperation with the Cardiovascular Surgery team to prevent systemic complications.

The full sequencing, specific interventions, and decision criteria are set out in the complete structured protocol →

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References

DOI: 10.1186/s12879-024-10122-8

In patients with valve involvement due to IE, we request that splenectomy or PCD be chosen in cooperation with the Cardiovascular Surgery team in order to prevent systemic complications.

We recommend that all patients receive blood cultures and, if possible, abscess cultures, and that extended-term antibiotic therapy be initiated and treatment be reviewed according to the antibiogram results.

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