INFECTIVE ENDOCARDITIS – CURRENT UNDERSTANDING OF PATHOGENIC MECHANISMS AND NEW MANAGEMENT OPTIONS
ANCA ȘARAN 1,2*, ALINA-ELENA ORFANU 1,2, MARA MÎNDRU 2, ANCA FLUERĂTORU 2, VIOLETA MOLAGIC 1,2, OANA ALEXANDRA GANEA 1,2, LAURENȚIU-MIHĂIȚĂ STRATAN 1,2, CĂTĂLIN TILIȘCAN 1,2, SORIN ȘTEFAN ARAMĂ 1,2, ADRIAN-GABRIEL MARINESCU 1,2, ȘTEFAN ANTONIU AIONESEI 1,2, VICTORIA ARAMĂ 1,²
¹ “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 “Prof. Dr. Matei Balș” National Institute for Infectious Diseases, Bucharest, Romania
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Infective endocarditis (IE) remains a significant global health challenge with increasing incidence and high mortality. The 2023 Duke-ISCVID criteria represent an important diagnostic update, incorporating advanced imaging modalities and microbiological criteria. Management continues to require a multidisciplinary approach with early involvement of infectious disease specialists and cardiac surgeons. The most significant update is the validation of oral step-down antibiotic therapy for selected patients with left-sided IE. The POET trial and further implementation studies have demonstrated that this approach is safe, effective, and associated with reduced hospital stays and potentially improved mortality in carefully selected minority of endocarditis patients. The ongoing dynamics of IE epidemiology and microbiology need permanent surveillance and periodic updates to diagnostic and therapeutic guidelines. This review summarizes current evidence on pathogenesis, clinical updates, microbiology, and the emerging role of oral antibiotic therapy. It also synthesizes data from major guidelines (American Heart Association, European Society of Cardiology, Duke-ISCVID criteria), trials (POET), and recent implementation studies.
