The Present and Future
State-of-the-Art Review
Challenges in Infective Endocarditis

https://doi.org/10.1016/j.jacc.2016.10.066Get rights and content
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Abstract

Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.

Key Words

cardiac device infection
infective endocarditis
TAVR

Abbreviations and Acronyms

18FDG-PET
18 fluorodeoxyglucose positron emission tomography
ACC
American College of Cardiology
AHA
American Heart Association
CDI
cardiac device infection
CHD
congenital heart disease
CI
confidence interval
CIED
cardiac implantable electronic device
CoNS
coagulase-negative staphylococci
CT
computed tomography
ESC
European Society of Cardiology
HR
hazard ratio
IE
infective endocarditis
IV
intravenous
MRI
magnetic resonance imaging
NVE
native valve infective endocarditis
PVE
prosthetic valve infective endocarditis
OPAT
outpatient parenteral antibiotic therapy
OR
odds ratio
RCT
randomized controlled trial
SPECT
single-photon emission computed tomography
TAVR
transcatheter aortic valve replacement
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography

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Dr. Baddour has received royalty payments from UpToDate, Inc.; and Editor-in-Chief payments from Massachusetts Medical Society (Journal Watch Infectious Diseases). The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.