Infective Endocarditis: New Challenges in a Classic Disease

Infective endocarditis is a relatively rare, but deadly infection, with an overall mortality of around 20% in most series. Clinical manifestations have evolved in response to significant epidemiological shifts in industrialized nations, with a move toward a nosocomial or health-care-related pattern, in older patients, with more episodes associated with prostheses and/or intravascular electronic devices and a predominance of staphylococcal and enterococcal etiology. Diagnosis is often challenging and is based on the conjunction of clinical, microbiological, and imaging information, with notable progress in recent years in the accuracy of echocardiographic data, coupled with the recent emergence of other useful imaging techniques such as cardiac computed tomography (CT) and nuclear medicine tools, particularly (18) F-fluorodeoxyglucose positron emission/CT. The choice of an appropriate treatment for each specific case is complex, both in terms of the selection of the appropriate agent and doses and durations of therapy as well as the possibility of using combined bactericidal antibiotic regimens in the initial phase and finalizing treatment at home in patients with good evolution with outpatient oral or parenteral antimicrobial therapies programs. A relevant proportion of patients will also require valve surgery during the active phase of treatment, the timing of which is extremely difficult to define. For all the above, the management of infective endocarditis requires a close collaboration of multidisciplinary endocarditis teams.

Automated summary

Infective endocarditis is a deadly infection with a relatively low occurrence rate. Clinical manifestations have changed in industrialized nations, with an increase in nosocomial or healthcare-related cases in older patients, associated with prostheses and/or intravascular electronic devices and a higher prevalence of staphylococcal and enterococcal causes. Diagnosis is challenging and relies on a combination of clinical, microbiological, and imaging information, with advancements in echocardiography and the emergence of other imaging techniques. Treatment selection is complex, with consideration of appropriate agents, dosage, and duration, and the possibility of combined antibiotic regimens. Valve surgery may be necessary for some patients, but the timing is difficult to determine. The management of infective endocarditis requires collaboration among multidisciplinary teams.