Clinical update on the diagnosis and treatment of bacterial endocarditis

Infective endocarditis (IE) represents the top of the pyramid of the relationship between humans and bacteria in that it is a less common form of infection than other localized infections in specific organ systems, but it may carry considerable morbidity and mortality. In a time when the practice of medicine is performed at the organ-system level through subspecialists, systemic diseases causing dysfunction in multiple organ systems like IE may be difficult to diagnose. The salient features of IE may present atypically or be obscured by the presence of preexisting and coexisting diseases. Early diagnosis of IE is important because of its high risk of morbidity and mortality. Management of the patient with IE is complex and requires interventions by internists, infectious disease specialists, cardiologists, and cardiothoracic surgeons. It represents one of only a few situations where bactericidal therapy is important to treatment efficacy. As such, the development of antimicrobial resistance in bacteria has the potential to impact the management of endocarditis most significantly. This review will touch on several aspects of endocarditis, including pathogenesis and treatment.