Infective endocarditis in the adult patient

Infective endocarditis (IE) is an uncommon disease that has an associated high morbidity and mortality. The basic pathology involves adherence of microorganisms to areas of endothelial damage or associated implanted cardiac devices, resulting in localized infection and the 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. The Duke criteria may aid diagnosis but they 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 their dental practitioners, without evidence of a corresponding increase in IE. This article summarizes how the diagnosis of IE is established and outlines current antibiotic treatment regimens.