title: The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century.
abstract: OBJECTIVE
  Infective endocarditis (IE) is a relatively infrequent infectious disease. It does, however, causes serious morbidity, and its mortality rate has remained unchanged at approximately 25%. Changes in IE risk factors have deeply impacted its epidemiology during recent decades but literature from low-income countries is very scarce. Moreover, prophylaxis guidelines have recently changed and the impact on IE incidence is still unknown.
  
  
  RESULTS
  In high-income countries, the proportion of IE related to prior rheumatic disease has decreased significantly and has been replaced proportionally by cases related to degenerative valvulopathies, prosthetic valves, and cardiovascular implantable electronic devices. Nosocomial and non-nosocomial-acquired cases have risen, as has the proportion caused by staphylococci, and the median age of patients. In low-income countries, in contrast, rheumatic disease remains the main risk factor, and streptococci the most frequent causative agents. Studies performed to evaluate impact of guidelines changes' have shown contradictory results. The increased complexity of cases in high-income countries has led to the creation of IE teams, involving several specialties. New imaging and microbiological techniques may increase sensitivity for diagnosis and detection of IE cases. In low-income countries, IE remained related to classic risk factors. The consequences of prophylaxis guidelines changes are still undetermined.
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ambrosioni
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Hernandez-Meneses
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Téllez
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pericàs
authors.affiliation: Cardiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Falces
authors.affiliation: Cardiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Tolosana
authors.affiliation: Cardiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Vidal
authors.affiliation: Microbiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.affiliation: Cardiovascular Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Quintana
authors.affiliation: Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Llopis
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain. jmmiro@ub.edu.
authors.forename: José M
authors.initials: JM
authors.lastname: Miro
keywords: Cardiac implantable electronic device (CIED) infections; Enterococci; Epidemiology; Guidelines; Infective endocarditis; Infective endocarditis-team (IE-team); Prophylaxis; Staphylococci; Streptococci; Transcatheter aortic valve implantation (TAVI) infective endocarditis