Abstract
Infective endocarditis (IE) remains a devastating disease with a high mortality. Its microbiology is changing with increasing incidence of Staphylococcus aureus infection, which often does not present with the typical signs that are incorporated into diagnostic criteria. With expanding indications for the implantation of cardiac devices, such as cardiac resynchronisation pacemakers and defibrillators, the incidence of device-related endocarditis is also increasing rapidly. The European Society of Cardiology (ESC) provides evidence-based guidelines regarding prophylaxis, diagnosis, and management of IE, the most recent of which were published in 2009. The aim of this review is to identify topical areas of controversy, where new research developments have shed some light since the last publication of these guidelines. The review focuses on antibiotic prophylaxis, investigating potential IE in S. aureus bacteraemia, and management of cardiac device-related IE. It is notable that not 1 in over 80 recommendations in the latest ESC guidelines is backed by data that are level of evidence A. Whilst it is clearly unethical to perform trials in this area of medicine against placebo, treatment algorithms and approaches to management can readily be compared with each other in a randomised way, and data using this approach are emerging. Increasing the quantity and quality of evidence when it comes to IE remains a significant challenge.
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