title: Infective endocarditis: prevention, diagnosis, and management.
abstract: Infective endocarditis (IE) is among the most severe infectious disease, the prevention of which has not decreased its incidence. The age of patients and the rate of health care-associated IE have increased as a consequence of medical progress. The prevention strategies have been subjected to an important debate and nonspecific hygiene measures are now placed above the use of antibiotic prophylaxis. Indeed, the level of evidence of antibiotic prophylaxis efficiency is low and the indications of its prescription have been restricted in the recent international guidelines. In cases carrying a high suspicion of IE, efforts should be made to rapidly identify patients with a definite or highly probable diagnosis of IE and to find the causative pathogen to ensure that appropriate treatment, including urgent valvular surgery, begins promptly. Although echocardiography remains the main accurate imaging modality to identify endocardial lesions associated with IE, it can be negative or inconclusive especially in cases of prosthetic valve or other intracardiac devices. Recent studies demonstrated the diagnostic value of other imaging strategies including cardiac computed tomography (CT), positron emission tomography/CT, radiolabelled leukocyte single-photon emission CT/CT, and cerebral magnetic resonance imaging. Novel perspectives on the management of endocarditis are emerging and offer a hope for decreasing the rate of residual deaths by accelerating the processes of diagnosis, risk stratification, and instauration of antimicrobial therapy. Moreover, the rapid transfer of high-risk patients to specialized mediosurgical centres (IE team), the development of new surgical modalities, and close long-term follow-up are of crucial importance.
authors.affiliation: Département de Cardiologie, Unité Nord Insuffisance cardiaque et Valvulopathies (UNIV), Centre Hospitalier Universitaitre de Marseille, Hôpital Nord, Aix-Marseille Université, Marseille, France; Département de Cardiologie, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France; URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France. Electronic address: franck.thuny@gmail.com.
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.affiliation: Service de Chirurgie Cardiaque, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Grisoli
authors.affiliation: Département de Cardiologie, Unité Nord Insuffisance cardiaque et Valvulopathies (UNIV), Centre Hospitalier Universitaitre de Marseille, Hôpital Nord, Aix-Marseille Université, Marseille, France; Département de Cardiologie, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cautela
authors.affiliation: Service de Chirurgie Cardiaque, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.affiliation: URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.affiliation: Département de Cardiologie, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
mesh_terms: D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D057054:Molecular Imaging; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed