title: My paper 10 years later: infective endocarditis in the intensive care unit.
abstract: BACKGROUND
  Although the recent literature contains plenty of studies concerning all aspects of infective endocarditis (IE), very few focus on severe IE requiring admission to the ICU.
  
  
  RESULTS
  In 2004, we published a report on the clinical spectrum and prognostic factors in 228 consecutive critically ill patients with IE. Septic shock, neurological complications and immunocompromised state were independently associated with in-hospital mortality. Cardiac surgery during the acute phase of EI was associated with better survival. A lot of information has been accumulated during the past 10 years on management of IE. Although three sets of blood cultures allow the identification of about 90% of cases, culture-negative IE still remains a diagnostic challenge. Blood-polymerase chain reaction in valve tissue may yield a microbiologic diagnosis. New imaging techniques such as positron emission tomography computed tomography (PET-CT) have shown additive value in patients with an intracardiac device or valvular prosthesis. Systematic cerebral magnetic resonance imaging can lead to modification of therapeutic plans. The decision to operate and the timing of cardiac surgery should take into account the presence of congestive heart failure, neurological complications, renal failure and multiorgan dysfunction syndrome. In 2011 and 2013, we published the results of a multicentre prospective observational study of 198 ICU patients with left-sided IE and confirmed that cardiac surgery was associated with better outcome. The strongest independent predictor of post-operative mortality was the pre-operative multiorgan failure score. Neurological failure also represented a major determinant of mortality, regardless of the mechanism of neurological complication.
  
  
  CONCLUSIONS
  In the present paper, we propose algorithms to optimize the medico-surgical approach.
authors.affiliation: Service de Réanimation, Medical Intensive Care Unit, Hôpital Bichat-Claude Bernard, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France, michel.wolff@bch.aphp.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000465:Algorithms; D006348:Cardiac Surgical Procedures / Q000401:mortality; D003422:Critical Care / Q000379:methods*; D003657:Decision Making; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006349:Heart Valve Diseases / Q000175:diagnosis*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D008297:Male; D016133:Polymerase Chain Reaction; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome