The Evolving Landscape of Infective Endocarditis: Difficult-to-Treat Resistance Bacteria and Novel Diagnostics at the Foreground

Abstract

Infective endocarditis (IE) is a relatively rare but potentially life-threatening disease characterized by substantial mortality and long-term sequelae among the survivors. In recent decades, a dramatic change in the profile of patients diagnosed with IE has been observed primarily in developed countries, most likely due to an aging population and a recent increase in invasive medical procedures. Nowadays, the typical IE patient is usually older, with complex comorbidities, and a history significant for cardiac disease, including degenerative heart valve disease, prosthetic valves, or cardiovascular implantable electronic devices (CIEDs). Moreover, as patient risk factors change, predisposing them to more healthcare-associated IE, the microbiology of IE is also shifting; there are growing concerns regarding the rise in the incidence of IE caused by difficult-to-treat resistance (DTR) bacteria in at-risk patients with frequent healthcare contact. The present review aims to explore the evolving landscape of IE and summarize the current knowledge on novel diagnostics to ensure timely diagnosis and outline optimal therapy for DTR bacterial IE.

Keywords: difficult-to-treat resistance bacteria; infective endocarditis; microbiology; novel diagnostics.

Figure 1

Main pillars of therapy success in case of IE. DTR: difficult-to-treat resistance; IE: infective endocarditis; MIC: minimum inhibitory concentration; MRSA: methicillin-resistant S. aureus; NVE: native valve endocarditis; OPAT: outpatient parenteral antibiotic therapy; PD: pharmacodynamics; PK: pharmacokinetics; PVE: prosthetic valve endocarditis; XDR: extensively drug-resistant.