title: Challenges in Infective Endocarditis.
abstract: Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
authors.affiliation: Department of Cardiology, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Cahill
authors.affiliation: Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: Aix-Marseille Universite, URMITE, Marseille, France; APHM, La Timone Hospital, Cardiology Department, Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.affiliation: Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Inserm, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Centre Hospitalier Universitaire de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.affiliation: APHM, La Timone Hospital, Cardiology Department, Marseille, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Salaun
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Gosta B
authors.initials: GB
authors.lastname: Pettersson
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.affiliation: Department of Cardiology, St. Thomas' Hospital, London, United Kingdom. Electronic address: bernard.prendergast@gstt.nhs.uk.
authors.forename: Bernard D
authors.initials: BD
authors.lastname: Prendergast
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D004864:Equipment and Supplies / Q000009:adverse effects; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents
keywords: TAVR; cardiac device infection; infective endocarditis