The Evolving Landscape of Infective Endocarditis: Past, Present, and Future

Infective endocarditis (IE) is a disease that has evolved over the past century in tandem with advances in medicine. Although initially reliant on histopathologic (and often postmortem) confirmation, the diagnostic approach has shifted toward reliance on microbiological culture and echocardiography as the cornerstones of diagnosis, as reflected by all iterations of diagnostic criteria. Recent developments in molecular diagnostics and advanced metabolic imaging techniques have enhanced the sensitivity and specificity of diagnosis, particularly in complex cases involving prosthetic material. While antimicrobial and surgical management strategies also have advanced incrementally, the affected patient population has concurrently become older and more medically complex, posing additional therapeutic challenges. Nevertheless, clinical outcomes have improved over time, though disparities in prognosis persist between high- and low-income settings. The increasing adoption of multidisciplinary management models and the establishment of international collaborative registries hold promise for generating globally representative data to inform future practice and reduce inequities in care in patients with IE.