Infective endocarditis (IE) represents an infection of the cardiac endothelium, usually a valve.1'2 Almost certainly lethal in the preantibiotic era, the use of appropriate anti-infectives and surgery now allows most persons to survive.3 The epidemiology of IE is changing in part because of increasing longevity, altered predisposing factors (e.g. less rheumatic fever and more intravenous drug use), and an increase in healthcare-associated disease (e.g. central intravenous catheters, hemodialysis access). In the United States and western Europe, the incidence of community-acquired native-valve IE is 1.7—6.2 cases/100,000 person-years.4 Alternatively, prosthetic valve endocarditis (PVE) accounts for 7-25% of cases ofinfective endocarditis in most developed countries.4 IE is generally considered to be one of the most serious infections because patients may be unstable at presentation and are at risk for complications that include systemic embolization and congestive heart failure.5'6 Management of IE involves control of both infectious and noninfectious complications. Successful antibiotic therapy requires bactericidal anti-infectives, most commonly administered in high parenteral doses for prolonged periods.7 With appropriate treatment, stability is generally noted within two weeks.6'8'9 Although some strategies exist for two-week courses of therapy, typical treatment requires 4-6 weeks of intravenous antibiotic therapy that has historically been rendered in the hospital.
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