Phys · cardiovascular
Infective Endocarditis
Also known as IE · bacterial endocarditis · subacute bacterial endocarditis · SBE · acute bacterial endocarditis · native valve endocarditis · prosthetic valve endocarditis · right-sided endocarditis · culture-negative endocarditis
Consultant-physician-depth guide to infective endocarditis — pathogenesis, Modified Duke criteria, microbiology, antibiotic therapy (native vs prosthetic valve), surgical indications, prophylaxis, and complications — structured for FRACP DWE and DCE preparation.
Checked against its sources on 14 Oct 2026
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FRACP DWEFRACP DCEMRCP Part 1MRCP Part 2MRCP PACESABIM Internal Medicine
Red flags
- New regurgitant murmur with heart failure — surgical emergency
- Staph aureus bacteraemia with prosthetic valve — presume IE until excluded
- Conduction block (PR prolongation) on ECG — aortic root abscess
- Vegetation greater than 10 mm with embolic event — urgent surgery
- Embolic stroke with haemorrhagic transformation — anticoagulation and surgery timing critical
- Fungal endocarditis — large friable vegetations, high embolic risk, surgical mandatory
Infective Endocarditis
Meet the patient
An adult with a bicuspid aortic valve presents with fever, a new early diastolic murmur, and positive blood cultures with echo evidence of endocardial involvement — the two major Duke criteria (typical blood culture, positive echocardiogram) with predisposition, fever, and vascular/immunologic phenomena as minors.[1][20]
The two questions that decide his admission: is this definite IE (2 major, 1 major + 3 minor, or 5 minor), and does he need the operating room (heart failure from a surgically correctable lesion mandates surgery)?[1][22]
References22ShowHide
- [1]Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis Clin Infect Dis, 2000.PMID 10770721
- [2]Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America Circulation, 2005.PMID 15956145
- [3]Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress JAMA, 2005.PMID 15972563
- [4]Moreillon P, Que YA Infective endocarditis Lancet, 2004.PMID 14726169
- [5]Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation, 2007.PMID 17446442
- [6]Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis N Engl J Med, 2012.PMID 22738096
- [7]Hubert S, Thuny F, Resseguier N, et al. Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort J Am Coll Cardiol, 2013.PMID 23906859
- [8]Thornhill MH, Dayer MJ, Forde JM, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study BMJ, 2011.PMID 21540258
- [9]Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Eur Heart J, 2015.PMID 26320109
- [10]Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis Eur Heart J, 2023.PMID 37622656
- [11]Imazio M The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice. J Cardiovasc Med, 2024.PMID 38916201
- [12]Bai AD, Steinberg M, Showler A, et al. Diagnostic Accuracy of Transthoracic Echocardiography for Infective Endocarditis Findings Using Transesophageal Echocardiography as the Reference Standard: A Meta-Analysis. J Am Soc Echocardiogr, 2017.PMID 28483353
- [13]Aronson MD, Bor DH Blood cultures. Ann Intern Med, 1987.PMID 3541726
- [14]Boleij A, van Gelder MM, Swinkels DW, et al. Clinical Importance of Streptococcus gallolyticus infection among colorectal cancer patients: systematic review and meta-analysis. Clin Infect Dis, 2011.PMID 21960713
- [15]Miro JM, Anguera I, Cabell CH, et al. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis, 2005.PMID 16028160
- [16]El-Ahdab F, Benjamin DK Jr, Wang A, et al. Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia. Am J Med, 2005.PMID 15745719
- [17]Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis, 2023.PMID 37138445
- [18]Papadimitriou-Olivgeris M, Monney P, Frank M, et al. Evaluation of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Criteria in a Multicenter Cohort of Patients With Suspected Infective Endocarditis. Clin Infect Dis, 2024.PMID 38330243
- [19]van der Vaart TW, Prins JM, Soetekouw R, et al. Prediction Rules for Ruling Out Endocarditis in Patients With Staphylococcus aureus Bacteremia. Clin Infect Dis, 2022.PMID 34272564
- [20]Durack DT, Lukes AS, Bright DK New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med, 1994.PMID 8154507
- [21]Gomes RT, Tiberto LR, Bello VN, et al. Dermatologic manifestations of infective endocarditis. An Bras Dermatol, 2016.PMID 28300907
- [22]Topan A, Carstina D, Slavcovici A, et al. Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases. Clujul Med, 2015.PMID 26609264