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Dr James Harrison

and Dr Bernard Prendergast

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date: 25 July 2021

Since the original description of endocarditis by William Osler in 1885 and its association with bacteraemia by Emanuel Libman in 1906, the epidemiology of this elusive condition has changed significantly. Despite significant advances in diagnosis and treatment, infective endocarditis remains a dangerous disease, particularly for people at risk because of a prosthetic valve, congenital heart disease, or a history of infective endocarditis, in whom morbidity and mortality approach 50%.

Recent decades have seen Staphylococcus aureus, often acquired as a result of nosocomial infection or intravenous drug abuse, overtake oral streptococci as the most common pathogen in infective endocarditis in developed nations. Infective endocarditis is also increasingly frequent in the elderly and in those with no previous documentation of valvular heart disease.

With these changes in mind, over the past few years international bodies of authority have significantly revised guidelines for the prevention, diagnosis, and treatment of infective endocarditis. Perhaps the most dramatic change is the reduction in antibiotic prophylaxis before dental and other invasive procedures. These guidelines also emphasize the important role of echocardiography in making an early diagnosis of infective endocarditis and that surgery should be performed earlier than previously recommended.

Unlike some other areas of cardiovascular medicine, the literature on endocarditis is not awash with large multi-centre, randomized, controlled trials, which reflects the challenging nature and heterogeneity of the condition. This chapter includes some of the most important clinical publications concerning the epidemiology, diagnosis, complications, and treatment of infective endocarditis and its possible prevention using antibiotic prophylaxis.

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