Infective endocarditis: prevention, diagnosis and management.

Infective endocarditis remains an important problem and the means of prevention are still insufficient. The causal bacteria have changed very little, but the incidence of nosocomial infections and endocarditis complicating intravenous drug abuse are increasing. The distinction between subacute and acute clinical presentations remains appropriate. Cardiac and neurological complications are frequent and carry a high risk of mortality. The diagnosis is obtained by the integration of clinical data and the results of blood cultures. Echocardiography is extremely useful for detecting vegetations, and for assessing the haemodynamic consequences and specific cardiac complications. Risk stratification can be obtained by correct integration of multiple parameters. The causal agent should be identified before the initiation of antimicrobial therapy. Surgery is frequently required, and should be performed rapidly when indicated.