Infective Endocarditis Diagnosis and Management

Infective endocarditis is a life-threatening infection of the cardiac endothelium, most often affecting the heart valves. It arises when bacteria or fungi enter the bloodstream and adhere to damaged or prosthetic valvular tissue, forming vegetations. Risk factors include pre-existing valvular abnormalities, intracardiac devices, intravenous drug use and healthcare-associated exposures. Diagnosis combines clinical assessment with laboratory and imaging modalities. Blood cultures remain essential to identify the causative organism, while echocardiography—transthoracic and transoesophageal—detects vegetations, abscesses and structural complications. The modified Duke criteria guide the integration of microbiological, imaging and clinical findings. Emerging molecular techniques, such as broad-range 16S rRNA sequencing and fluorescence in-situ hybridisation, enable detection of fastidious pathogens when cultures are negative. Management hinges on prolonged, targeted antimicrobial therapy and timely surgical intervention for heart failure, uncontrolled infection or high embolic risk. A multidisciplinary “endocarditis team” approach has been shown to improve outcomes by coordinating cardiology, cardiac surgery, infectious diseases and microbiology expertise. Preventive strategies focus on antibiotic prophylaxis for high-risk patients prior to invasive procedures, strict asepsis during device implantation and enhanced surveillance of prosthetic materials. Globally, rising incidence and shifting epidemiology underscore the need for tailored diagnostic pathways and equitable access to specialised care.

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Infective Endocarditis Diagnosis and Management publication trend

The graph below shows the total number of articles in infective endocarditis diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Duke criteria: A validated set of clinical, microbiological and imaging parameters for diagnosing infective endocarditis.

Fluorescence in-situ hybridisation (FISH): A molecular technique that uses fluorescent probes to detect bacterial RNA sequences in tissue samples.

Valve vegetation: An aggregate of platelets, fibrin, microorganisms and inflammatory cells adherent to endocardial tissue.

Paravalvular complication: Extension of infection beyond the valve annulus, forming abscesses or fistulae.

Socio-demographic index (SDI): A composite measure of income, education and fertility used to compare health outcomes across regions.

References

1. Endocarditis associated with contamination of cardiovascular bioprostheses with Mycobacterium chelonae: a collaborative microbiological study. The Lancet Microbe (2024).
2. Endocarditis prevention: time for a review of NICE guidance. The Lancet Regional Health - Europe (2024).
3. The Global, Regional, and National Burden and Trends of Infective Endocarditis From 1990 to 2019: Results From the Global Burden of Disease Study 2019. Frontiers in Medicine (2022).