Modern epidemiology, prophylaxis, and diagnosis and therapy for infective endocarditis.

Infective endocarditis (IE) is a rare disease. Although its incidence and bacteriology have remained relatively stable in outpatient populations without injection drug use, health care-associated infections, particularly with staphylococcus, are becoming more common. Large-scale prospective clinical trials are unavailable to guide strategies for preventing IE, timing surgical intervention, and avoiding complications. We continue to rely on new data from smaller series and large observational databases to track these changes and improve care of patients. At the present time, there are several controversies regarding best practices in IE. In this review, we address the following questions: What is the future of recommendations for antibiotic prophylaxis against IE? How should we best use echocardiography in diagnosis, management and follow up of IE patients? What are the most appropriate antibiotic regimens for different patients in the face of shifting microbiology and demographics? Lastly, how should patients be selected for early surgery to avoid the complications of these infections?