Infective endocarditis prophylaxis: moving from dental prophylaxis to global prevention?

Infective endocarditis (IE) is an infectious disease which mainly affects elderly patients. Staphylococcus aureus is the main microorganism and IE, which used to be associated with a previously known heart disease, is now associated with healthcare procedures. For a long time, it was thought necessary to prevent IE with antibiotics before starting many invasive procedures. But in the last few years, there has been a change, with a drastic limitation on the situations in which antibiotic prophylaxis is required. Epidemiological studies emphasize changes in the profile of IE, which is moving from a streptococcal disease in patients with previously known heart disease to a staphylococcal healthcare-associated disease in elderly patients suffering from many comorbidities or having intracardiac devices. These changes should lead us to question the validity of our current management of antibiotic prophylaxis. There are already recommendations from the American Heart Association (AHA) for the prevention of implantable cardiovascular electronic device implantation, but apart from this particular situation, should we not extend prophylaxis to more comprehensive prevention in patients who have comorbidities? To find an answer, we need to acquire more data on the pathophysiology of IE while continuing epidemiological surveillance of the disease.