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Infective endocarditis

Nature Reviews Cardiology volume 8, pages 322–336 (2011)Cite this article

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Abstract

Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease—mostly chronic rheumatic heart disease—IE now tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices, and patients exposed to healthcare-associated bacteremia. As a result, skin organisms (for example, Staphylococcus spp.) are now reported as the pathogen in these populations more often than oral streptococci, which still prevail in the community and in native-valve IE. Moreover, progress in molecular diagnostics has helped to improve the diagnosis of poorly cultivable pathogens, such as Bartonella spp. and Tropheryma whipplei, which are responsible for blood-culture-negative IE more often than expected. Epidemiological data indicate that IE mostly occurs independently of medico-surgical procedures, and that circumstantial antibiotic prophylaxis is likely to protect only a minute proportion of individuals at risk. Therefore, new strategies to prevent IE—including improvement of dental hygiene, decontamination of carriers of Staphylococcus aureus, vaccination, and, possibly, antiplatelet therapy—must be explored.

Key Points

  • Infective endocarditis (IE) remains universally lethal if not aggressively treated

  • Medical progress has altered the epidemiology of IE

  • Healthcare-associated IE has become a major issue in industrialized countries

  • Prophylaxis for IE has been questioned and new guidelines have been proposed

  • Successful therapy for IE is being challenged by the development of antibiotic resistance

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Figure 1: Indications for echocardiography in cases of suspected IE.
Figure 2: Diagnostic strategies in blood-culture-negative infective endocarditis, as recommended by Fournier et al.98

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Acknowledgements

Y.-A. Que was supported by Swiss National Science Foundation/Swiss Medical Association (FMH) grant # PASMP3-123226 and a grant from the SICPA Foundation. P. Moreillon is supported by grant 3200B0-113854 from the Swiss National Science Foundation.

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland

    Yok-Ai Que

  2. Department of Fundamental Microbiology, University of Lausanne, Biophore 2416.1, Lausanne, 1015, Switzerland

    Philippe Moreillon

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Both authors contributed to discussion of content for the article, researched data to include in the manuscript, wrote, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

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Correspondence to Philippe Moreillon.

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P. Moreillon declares that he has been a consultant for and has received grant/research support from Novartis and Wyeth Pharmaceuticals during the past 2 years.

Y. A. Que declares no competing interests.

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Que, YA., Moreillon, P. Infective endocarditis. Nat Rev Cardiol 8, 322–336 (2011). https://doi.org/10.1038/nrcardio.2011.43

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