Infective endocarditis: how well are we managing our patients?

Infective endocarditis remains a major cause of morbidity and mortality in the U.S., with an estimated number of 10–15,000 new cases being diagnosed each year (1). Although the number of cases of infective endocarditis occurring as a result of rheumatic disease is diminishing, this reduction in cases has been replaced by an increased incidence of endocarditis among intravenous drug users and older people (2). Of late, the ability to appropriately diagnose infective endocarditis has been significantly improved through the development of specific diagnostic criteria that use clinical findings, pertinent laboratory data and either the transthoracic or transesophageal echocardiogram. Guidelines for the prevention of bacterial endocarditis through both appropriate antimicrobial prophylaxis and other preventive measures including proper dental care, and so forth, have been developed by the American Heart Association and other organizations (3). Expert groups in Europe (4), including France, the source of an accompanying article in this issue of the Journal of the American College of Cardiology (5), have also published guidelines very similar in nature. Guidelines have also been developed to aid in the diagnosis of infective endocarditis and to assist in its management after the diagnosis has been made (6). These include guidelines for initial evaluation, antibiotic treatment, appropriate surgical intervention and follow up after completion of antibiotic treatment.