Key Points

1. The diagnosis of infective endocarditis (IE) requires early clinical suspicion, based on history and physical examination, and can be supported by appropriate microbiological laboratory investigations (e.g., blood culture, serology) and/or imaging (e.g., echocardio-gram).

2. Empiric antimicrobial therapy, based on the most likely pathogens identified from clinical evaluation, may need to be instituted, particularly in patients who are clinically unwell. Once a pathogen has been identified, antimicrobial susceptibility testing must be performed, including determination of the minimal inhibitory concentration (MIC) and the presence of in vitro synergy, where applicable.

3. Effective antimicrobial therapy requires the administration of bactericidal agents for an extended period of time.

4. Health care providers should be aware of the possible intracardiac and extracardiac complications of IE.

5. The role of surgical intervention in the management of IE has likely strongly contributed to reduced mortality rates. Indications for surgical intervention exist, with congestive heart failure (from any cause) being the principal need for surgery. When appropriate, early surgical intervention should be performed.

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