Management of infective endocarditis: challenges and perspectives.
Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. We review the strengths and limitations of present therapeutic strategies and propose future directions for better management of endocarditis according to the most recent research. Novel perspectives on the management of endocarditis are emerging and offer hope for decreasing the rate of residual deaths by accelerating the process of diagnosis and risk stratification, reducing delays in starting antimicrobial therapy, rapid transfer of high-risk patients to specialised medico-surgical centres, development of new surgical methods, and close long-term follow-up.
Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France; Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France.
Franck
F
Thuny
Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Dominique
D
Grisoli
Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Frederic
F
Collart
Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Gilbert
G
Habib
Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France. Electronic address: didier.raoult@gmail.com.
Didier
D
Raoult
D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006801:Humans; D011379:Prognosis