Microbiology Trends

The microbiology of infective endocarditis (IE) has evolved significantly over the last century [1]. Previously a community-acquired disease affecting predominantly patients with rheumatic heart disease, IE is now being seen in new populations including IV drug users (IVDU), patients with prosthetic valves, and patients infected through health-care-associated bacteremia. Improved blood culture technologies and non-culture laboratory methods have also resulted in a lower rate of culture-negative cases. Because of differing proportions of particular risk groups, the etiologic agents responsible for causing IE vary significantly among continents, countries, regions within countries, and even among different years in an individual hospital. The approximate proportions of IE cases caused by different groups of microorganisms as recently published by Mylonakis and Calderwood are provided in Table 4.2 [2].

This discussion of the etiologic agents of IE will begin with native valve endocarditis followed by consideration of special situations including prosthetic valve endocarditis, IE in injection drug users, and culture-negative endocarditis.

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