Abstract
Infective endocarditis (IE) remains a serious illness. The incidence is rising slowly, the mortality has not improved and approaches30%.
The main characteristics of the disease have changed significantly. The patients are older, frailer, and with increasing comorbidities.The proportion of health care associated with IE has been increasing, too.
Staphylococci have become the predominantcausative organisms, particularly Staphylococcus aureus. Blood cultures and echocardiography are still the cornerstones in thediagnosis of IE.
Especially in patients with suspected prosthetic valve endocarditis and cardiac device infections additional methodshave proved to be useful (cardiac CT, nuclear imaging). In blood culture-negative cases some of the serological assays arerecommended.
Molecular methods (polymerase chain reaction /PCR/) may be beneficial particularly in valvular biopsies. Longtermantibiotic treatment is the mainstay of IE treatment; nevertheless, surgery is indicated in approximately half of the cases.Unfortunately, there is a lack of evidence-based data and many questions remain to be resolved (antibiotic protocols, durationof treatment, switch to oral antibiotics, outpatient parenteral antibiotic therapy, timing of surgery).
Because of the complexity ofIE, a multidisciplinary approach can improve the prognosis of IE patients.