[Infective endocarditis: a serious and rare condition that needs to be handled in experienced hospitals].

Rev Esp Cardiol. 2005;58(10):1145-7 1145 The profile of infective endocarditis has changed substantially over time. The traditional form of the disease, which affects patients with rheumatic valvular disease caused by Streptococcus viridans, has become less common. Recent studies,1 as well as the European Heart Survey on Valvular Diseases2 and the ICE (International Collaboration on Endocarditis Investigation) registry,3 have clearly shown that endocarditis now affects elderly subjects, often with no known history of valvular disease. Moreover, the causative agents now tend to be aggressive pathogens, particularly staphylococci. Recently, investigators have reported risk factors for endocarditis, such as diabetes, immunodepression, and renal impairment.4 The increase in nosocomial transmission of endocarditis has received much attention, and prosthetic valve endocarditis and pacemaker endocarditis are also occurring increasingly among patients with such prostheses or devices. These changes in the disease profile have not lessened our deep concerns about the prognosis for endocarditis. In fact, even with better diagnostic and surgical techniques and increasing use of surgery during the active phase of the disease, the levels of mortality have not declined,5,6 settling at around 10% to 15% in forms caused by S viridans and at more than 30% for endocarditis caused by other microorganisms.7,8 Moreover, endocarditis is an uncommon disease treatment of which is unquestionably complex and difficult. This may be why daily clinical practice sometimes clearly diverges from the recommendations,10,11 despite the availability of recent clinical guidelines.9 ED I TO R I A L S