Infective endocarditis: a diagnostic and therapeutic challenge for the new millennium

Scand J Infect Dis. 2000;32(4):343-56. doi: 10.1080/003655400750044908.


This review on infective endocarditis (IE) is based on clinical studies carried out in Göteborg since 1984, data obtained from a Swedish national registry of IE since 1995 and existing literature. IE is still a great challenge in medicine, although improved bacteriological and echocardiographical techniques have facilitated diagnosis. In Sweden the incidence of IE is about 6 per 100,000 inhabitants a year. During recent decades IE has changed character. Patients are older, fever is often the only major symptom and a new murmur is less frequent. Streptococci, including viridans species and staphylococci, are still the most common bacteria found. Antibiotic treatment for 4-6 weeks may reduce mortality of IE to 30-50%. For further reduction, heart surgery is necessary in 20-25% of patients in order to remove infected tissues and restore valve function. Rapid diagnosis, careful antibiotic treatment and optimal surgery may reduce mortality associated with treatment to 10%. Antibiotic treatment is still mainly empiric. Penicillin and aminoglycoside for 2 weeks only seem to be effective in uncomplicated IE caused by alpha-streptococci. Otherwise, 4 weeks of treatment is needed, but aminoglycoside treatment may be reduced to 1 week in general and 2 weeks for enterococcal infections.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Endocarditis, Bacterial / diagnosis
  • Endocarditis, Bacterial / etiology
  • Endocarditis, Bacterial / therapy*
  • Enterococcus / drug effects
  • Female
  • Humans
  • Male
  • Risk Factors
  • Staphylococcal Infections / drug therapy
  • Streptococcal Infections / drug therapy


  • Anti-Bacterial Agents