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Endocarditis: basics
  1. S J Eykyn
  1. Department of Microbiology, St Thomas' Hospital, London, UK
  1. Professor SJ Eykyn, Department of Microbiology, St Thomas' Hospital, London SE1 7EH, UKsusannah.eykyn{at}

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Microbiological expertise is essential in the diagnosis, management, and prevention of infective endocarditis (IE). Unfortunately old habits die hard and there are still doctors who persist in referring to this infection as “SBE” (subacute bacterial endocarditis) whether the patient has been ill for days, weeks or months, and think that it is generally caused by a microbe they know as “Strep viridans” and can often be blamed on dentists. IE cannot be considered as a homogeneous infection. It may arise in the community or, increasingly, in hospital or as a result of procedures undertaken in hospital; it may affect native valves (previously normal or abnormal) or prosthetic valves and may occur in intravenous drug users (IVDU) as well as those who do not use drugs. Although overall most cases of IE are caused by staphylococci, streptococci, and enterococci, the incidence of each group of organisms differs in the various types of IE. A wide variety of organisms account for the infections not caused by these three genera, and virtually every organism known to microbiologists has been reported to cause IE, albeit very rarely. At St Thomas' Hospital, in some 650 cases of IE seen over 30 years we have encountered infections caused byErysipelothrix rhusiopathiae,Listeria monocytogenes,Campylobacter fetus,Lactobacillus rhamnosus, andHistoplasma capsulatum!

Native valve endocarditis

Native valve endocarditis (NVE) is the most common type of IE. The affected valve may be previously normal or abnormal, and the infection is usually acquired in the community but increasingly is also acquired in hospital.

Community acquired NVE

Community acquired NVE is now as likely to be caused by staphylococci, usually Staphylococcus aureusbut sometimes by coagulase negative staphylococci, as it is to be caused by oral (“viridans”) streptococci (fig 1), most commonly those of the sanguis andoralis groups. Enterococci (until …

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