title: Systematic Search for Present and Potential Portals of Entry for Infective Endocarditis.
abstract: BACKGROUND
  Looking for and treating the portal of entry (POE) of infective endocarditis (IE) is important, but published research on this topic is nonexistent.
  
  
  OBJECTIVE
  The goal of this study was to systematically search for the POEs of present and potentially new episodes of IEs.
  
  
  METHODS
  Patients were systematically seen by a stomatologist, an ear, nose, and throat specialist, and a urologist; women were systematically seen by a gynecologist; patients were seen by a dermatologist when there were cutaneous and/or mucous lesions. Colonoscopy and gastroscopy were performed if the microorganism came from the gastrointestinal tract in patients ≥50 years of age and in those with familial histories of colonic polyposis. Treatment of the POE was systematically considered.
  
  
  RESULTS
  The POEs of the present IE episodes were identified in 74% of the 318 included patients. The most frequent POE was cutaneous (40% of identified POEs). It was mainly (62% of cutaneous POEs) associated with health care and with intravenous drug use. The second most frequent POE was oral or dental (29%). A dental infectious focus was more often involved (59% of oral or dental POEs) than a dental procedure (12%). POEs were gastrointestinal in 23% of patients. Colonic polyps were found in one-half of the patients and colorectal adenocarcinomas in 14%. Performance was good regarding the search for an oral or dental or a colonic potential POE, which were found in 53% and 40% of patients, respectively.
  
  
  CONCLUSIONS
  Our search for the POEs of present IEs was often successful, as was searching for an oral or dental or a gastrointestinal POE of a new IE episode. We advise the systematic performance of stomatologic examinations in patients with IE and performance of colonoscopy in patients ≥50 years of age or at high risk for colorectal cancer.
authors.affiliation: Department of Cardiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France. Electronic address: francois.delahaye@chu-lyon.fr.
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: Department of Cardiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
authors.forename: Ali
authors.initials: A
authors.lastname: M'Hammedi
authors.affiliation: Department of Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Guerpillon
authors.affiliation: Department of Cardiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
authors.forename: Guy
authors.initials: G
authors.lastname: de Gevigney
authors.affiliation: Department of Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: André
authors.initials: A
authors.lastname: Boibieux
authors.affiliation: Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dauwalder
authors.affiliation: Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Bouchiat
authors.affiliation: Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
mesh_terms: D000368:Aged; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D003113:Colonoscopy / Q000379:methods; D003729:Dental Care / Q000379:methods; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005260:Female; D005602:France / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods; D017192:Skin Diseases, Bacterial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D009057:Stomatognathic Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology
keywords: colonic abnormalities; cutaneous infections; dental infections