DEFINITE, POSSIBLE OR EXCLUDED INFECTIVE ENDOCARDITIS? POLYMORBID ELDERLY PATIENTS IN SEPSIS WITH/WITHOUT CLEAR FOCUS - 2 CASE REPORTS.

Introduction: Infective endocarditis in its untreated form is a malignant disease. Confirmed then requires long-term antibiotic or surgical treatment with lifelong consequences. Therefore, in the case of unclear conditions, great emphasis is placed on the definitive determination of this diagnosis.
Cases: An 88 year old polymorbid woman was admitted for worsening dyspnea in the setting of decompensated heart failure type HFmrEF. During hospitalization, sepsis develops. The sources of infection are continuously investigated. When three minor criteria are met, including nonspecific findings on pacing lead at TOE, possible infective endocarditis was considered. After further investigation, including Pet CT, synovitis of the left knee joint was gradually diagnosed.
A 78 year old polymorbid man admitted in September 2022 for day-long chills and shivers. Staphylococcal sepsis was diagnosed with osteomyelitis. Infective endocarditis also considered and unconfirmed. Early December 2023 admitted for febrile illness. At the forefront of heart failure decomplication, high inflammatory activity. TOE demonstrated fluttering echogenicity on aortic valve. Evaluated as infective endocarditis of the aortic valve with recommendation for cardiac surgery after treatment of the infection. This is ongoing at the time of abstract submission.    Conclusion: A polymorbid patient in sepsis should be considered acutely and critically ill until complete remission. Such needs a comprehensive multidisciplinary approach and close cooperation between the district and the centre.Evaluation of the overall clinical status with simultaneous use of modern laboratory and imaging procedures is a necessity. New recommendations for the treatment of infective endocarditis will certainly improve the management of the diagnosis and treatment of this disease.