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Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis
  1. Khawaja M Talha1,
  2. Daniel C DeSimone1,2,3,
  3. M Rizwan Sohail1,2,3,
  4. Larry M Baddour1,2,3
  1. 1 Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
  2. 2 Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
  3. 3 Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
  1. Correspondence to Dr Khawaja M Talha, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 1st street SW, Rochester, Minnesota 55902, USA; talha.khawaja{at}


Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase ‘subacute bacterial endocarditis’, so-called ‘SBE’, was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.

  • endocarditis
  • valve disease surgery
  • prosthetic heart valves
  • epidemiology

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  • Correction notice This article has been corrected since it was published Online First. The author name ‘M Rizwan Sohail’ was incorrectly spelt as ‘Sohail M Rizwan’ and the supplementary tables file was replaced in line with the guideline recommendations referenced.

  • Contributors All authors have contributed to the drafting and approval of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LMB−consultant, Boston Scientific. SM−Medtronic, Spectranetics, Boston Scientific.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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