How to prevent infective endocarditis in 2020? Practical issues

The incidence of infective endocarditis (IE) continues to rise in many populations and is typically accompanied by a shift to healthcare‑associated staphylococcal species. Despite efforts with aggressive antibiotic therapy and increasing rates of surgical intervention, little progress has been made to reduce mortality. Disease prevention is therefore a crucial part of limiting its effects. Prevention should target each point in the pathogenic triad of IE: initiating bacteremia, adhesion to substrate, and proliferation of pathogenic species. Preventative strategies should focus on at‑risk patients undergoing high‑risk procedures, and these patients and procedures can now be identified by quantitative risk estimates. The attendant risk resulting from a procedure must then be placed in the perspective of the day‑to‑day risk, and the resulting balance can inform the benefit of prophylactic antibiotics. Implantable devices are a major risk factor for IE, and novel coatings and designs may be effective in risk reduction. Guidelines differ worldwide and a consensus has yet to be reached on who should receive pre‑ and periprocedural antibiotics