Infective endocarditis

With a mortality of about 30%, management of endocarditis remains a challenge for physicians. Staphylococcus infection has increased over the years and modified the epidemiology of the disease. Decisions should be organised within multidisciplinary teams to reduce mortality associated with endocarditis. Diagnostic is a combination of clinical, microbiologic and echo cardiographic criteria using the Duke criteria to confirm the infection. Since European guidelines in 2015, imagery can also be used as a major criterion to help the diagnosis. Echography is the reference exam for diagnostic and follow-up of the patients but the use of scan and nuclear imaging is increasing to help difficult diagnosis situations or to improve the search for complications. Endocarditis can be complicated by cardiac complications (abscess, fistula, valvula's destruction) or embolic complications, which can be peripheral or neurologic and are responsible for a big part of the morbi-mortality of the disease. Antibiotics management is well defined in the last European guidelines. If most studies concluded the benefits of early surgery, even after a recent stroke, timing of surgery for the prevention of embolic events remains an issue in the management of these patients and needs to be balanced with the surgical risk. Incidence of cardiac implantable device's endocarditis increases constantly. Ablation of the device is always recommended and reimplantation should be delayed after antibiotics efficacy. Since 2002, use of antibiotic prophylaxis for invasive care has been reduced to only dental care in a small group of patients in French's guidelines. Only patients with prosthetic valves, unoperated cyanogenic heart diseases and patients with prior endocarditis should receive this prophylaxis.