Infective endocarditis: New recommendations and perspectives

Abstract

Infective endocarditis (IE) is a serious disease with an incidence ranging from 30 to 100 episodes/million patient-years (van der Meer et al. 1992a; Hogevik et al. 1995; Hoen et al. 2005). Mortality is high since more than one-third of patients will die within the first year of diagnosis (Cabell et al. 2002; Thuny et al. 2005). Prevention strategies have not lowered the incidence of this life-threatening disease (van der Meer et al. 1992a; Hogevik et al. 1995; Hoen et al. 2002; Berlin et al. 1995). Despite improvements in the diagnostic and therapeutic strategies, the fatality rate due to IE has not significantly decreased since the end of the 1970s. Important changes in the epidemiological profile of this disease that have occurred over the past few decades can explain a part of this situation. In fact, the age of patients and the incidence of health care-associated IE have increased as a consequence of the medical progress (Fowler et al. 2005; Benito et al. 2009; Sy and Kritharides 2010). Thus, the most frequent causative agents now tend to be aggressive pathogens such as staphylococci, resistant-enterococci, or fungi. Although significant geographical variations exist, a significant increase in the rate of staphylococcal IE has been reported in industrialized countries (Fig. 15.1) (Cabell et al. 2002; Fowler et al. 2005). Therefore, efforts should be made to develop new strategies at each step of IE management to reduce the residual causes of IE-related deaths. Challenges in IE management include (i) cost-effective measures of prevention, (ii) improvement of diagnostic strategies to reduce the delays for the initiation of the appropriate treatment, (iii) and better identification patients who require close monitoring and urgent surgery (Thuny et al. 2012).