Dramatic Reduction in Infective Endocarditis–Related Mortality With a Management-Based Approach

Abstract

Infective endocarditis (IE) remains among the deadliest infectious disease. Despite changes in the profile of IE over the years^1,2 and better medical^3-5 and surgical management,⁶ in-hospital mortality has not declined, still ranging from 11% to 36%.^1,6-8 Many factors have an impact on the outcome of IE, including the virulence of the microorganism, the characteristics of the patients, the presence of underlying disease, the delay in diagnosis and/or treatment, the surgical indications, and the timing of surgery. In addition, many professionals are involved in the management of IE including cardiologists, microbiologists, infectious diseases specialists, and surgeons, complicating the already difficult treatment, and in fine no 2 patients receive the same treatment. Moreover, the deviations from the published guidelines^9-11 may have a negative impact on the patient's prognosis. Preliminary results from our center showed that there were unfounded modifications in antimicrobial therapy and that surgical indications differed from one surgeon to another.