Infective endocarditis in the adult patient

Infective endocarditis (IE) is an uncommon disease with a high morbidity and mortality. The basic pathology involves adherence of microorganisms to areas of endothelial damage or associated implanted medical devices, such as prosthetic valves or pacemakers, resulting in localized infection and formation of vegetations. Complications include sepsis, valvular failure and embolization. Staphylococci and streptococci are the predominant causes of IE. Blood cultures and echocardiography are key diagnostic tests, but a diagnosis of IE can still be difficult to establish. Serological tests, particularly for fastidious microorganisms, can assist when blood cultures are negative. The Duke criteria can aid diagnosis but lack sensitivity, particularly when blood cultures are negative or transthoracic echocardiography images are non-diagnostic. Antibiotics are the mainstay of treatment, but surgical debridement and valvular surgery are frequently required. Recent changes in antibiotic prophylaxis for those considered to be at risk of IE have reduced the number of patients given antimicrobials by dental practitioners. This article summarizes how to diagnose IE and outlines current antibiotic treatment regimens.