Endocarditis infecciosa asociada a bacterias gramnegativas resistentes a carbapenémicos: revisión sistemática

Abstract

Introduction: Endocarditis is a serious infection capable of causing valvular destruction, embolic complications, and organ failure. In recent years, increasing resistance of Gram-negative bacilli to carbapenems has created a new scenario for this disease because of their growing presence in healthcare settings and the diagnostic and therapeutic challenges that may arise when they act as etiological agents. Objective: To analyze the available scientific evidence on infective endocarditis caused by carbapenem-resistant Gram-negative bacteria, providing a basis for the understanding and comprehensive management of this emerging entity in medical practice. Methods: A PRISMA 2020 systematic review of cohort studies published from 2015 to 2025 involving adults with confirmed infective endocarditis, comparing the etiology of carbapenem-resistant Gram-negative bacilli. Results: Carbapenem-resistant Gram-negative bacilli accounted for approximately 1.1% of all cases of endocarditis and 11% of cases in a series of endocarditis caused by Gram-negative. A high incidence of prosthetic was documented, with an in-hospital mortality rate ranging from 5% to 36.5%. A correlation was identified between advanced resistance, persistent bacteremia, and the absence of surgical intervention, along with the risk of resistance developing during treatment. Conclusions: It was observed that this type of endocarditis is uncommon but associated with high clinical severity, complex hospital settings, and exposure to procedures or prosthetic material. Outcomes depend on frailty, comorbidities, and an individualized antimicrobial approach with close microbiological monitoring. Keywords: carbapenemases, endocarditis, bacterial infections, prosthetic heart valves, bacterial drug resistance