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Prevention and treatment of endocarditis 

Prevention and treatment of endocarditis
Prevention and treatment of endocarditis

Dominique Grisoli

and Didier Raoult

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date: 16 May 2022

Initially always lethal, the prognosis of infective endocarditis (IE) has been revolutionized by antibacterial therapy and valve surgery. Nevertheless, it remains one of the deadliest infectious diseases, with ≥30% of patients dying within a year of diagnosis. Its incidence has also remained stable at 25–50 cases per million per year, and results predominantly from a combination of bacteraemia and a predisposing cardiac condition, including endocardial lesions and/or intracardiac foreign material. While antibiotic prophylaxis is recommended by various learned societies to cover healthcare procedures with the potential of causing bacteraemia in at-risk patients, there is no evidence to support this strategy. Even though the benefits are hypothetical, national guidelines should still be followed to avoid medico-legal issues. General preventive measures, such as education of clinicians and at-risk patients appear to be more crucial. Invasive procedures, especially intravenous catheterization, should be kept to the minimum possible. The severity of IE mandates a multidisciplinary and standardized approach to treatment, with involvement of dedicated surgeons within specialist centres. Standardized antibiotic protocols have produced dramatic reductions in hospital and 1-year mortality in reference centres. Most deaths now result from complications that constitute definite surgical indications, so optimization of surgical management and avoidance of delay will clearly improve prognosis. This disease has now entered an ‘early surgery’ era, with a more aggressive surgical approach showing promising results. Conditions such as septic shock, sudden death, and vancomycin-resistant staphylococcal endocarditis still constitute therapeutic and research challenges, and justify an important role for specialist centres.

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