The infective endocarditis team: recommendations from an international working group

The estimated incidence is 3-10 episodes each year per 100 000 population. 1 In industrially developed countries, IE increasingly occurs in older adults with intracardiac devices (pacemakers and implantable defibrillators), replacement heart valves and medical interventions such as haemodialysis. 2-4 Younger age groups are also affected, particularly intravenous drug users and those with adult congenital heart disease. 5 Staphylococci are now the most common causative organisms in international series and streptococci the second most common. 6 Resistance to antimicrobial agents, particularly vancomycin, is increasing. 1 7 Patients with IE remain in hospital for a median of 4-6 weeks 8 9 and approximately a half require inpatient cardiac surgery. 1 10 11 The inhospital mortality rate is about 20% 8 12 but varies widely according to age, comorbidity, heart failure, the presence of prosthetic material and the organism. 13 For example, in prosthetic valve IE with associated renal failure, the reported mortality may be 40%-50% 14 15 and with severe heart failure as high as 64%. [...]it may be difficult or impractical to set up comprehensive specialist IE care in small hospitals since the incidence of IE is low. [...]there must be strong links between referring hospitals and the specialist IE team at the cardiothoracic centre.