[Diagnosis and treatment of infective endocarditis]

In infective endocarditis (IE) initial symptoms and clinical findings are unspecific. It is thus of the utmost importance that physicians primarily involved consider IE a potential diagnosis. Any delay in diagnosis and thus in adequate antimicrobial therapy has a significant negative prognostic influence. Any subject suspected of having IE should immediately have a transthoracic echocardiography (TTE) by an experienced examiner. If the TTE results are inconclusive, transoesophageal echocardiography (TEE) has to be performed without delay. Other steps in diagnosis, medical and surgical therapy follow established and evidence-based guidelines. Antimicrobial regimens are standardized for IE, for which demonstration of causative microorganisms from blood cultures or other microbiological sources are unavoidable. If there are problems in diagnosis, if difficult-to-treat microorganisms are isolated or difficult-to-treat situations (e.g. locally uncontrolled infections) complicate active IE, a reference centre should be involved.