Advances in the Antimicrobial Management of Infective Endocarditis

Infective endocarditis (IE) is an uncommon infectious disease, with an annual incidence ranging from 3 to 7 cases per 100,000 people per year in contemporary population studies. Although relatively rare, IE continues to be characterized by high morbidity and mortality. The complexity of clinical cases—often involving elderly patients with multiple comorbidities—largely explains the unfavorable outcomes observed.



The diagnosis of endocarditis encompasses various types of infections, ranging from true infections of native or prosthetic heart valves to those involving cardiovascular implantable electronic devices (CIEDs), left ventricular assist devices (LVADs), MitraClips, and other devices used in the management of heart failure.



One of the main challenges in IE management concerns accurate etiological diagnosis, which relies on traditional blood cultures as well as more recent molecular biology techniques such as PCR and next-generation sequencing (NGS).



Therapeutic data on endocarditis are mostly derived from outdated clinical trials, with only a limited number of randomized clinical studies available. Therefore, additional data are needed to optimize the therapeutic approach—from initial intravenous antibiotic therapy to subsequent transition to oral treatment.



Particular attention should be given to the management of non-explantable devices (such as prosthetic valves and CIEDs), where the implementation of effective therapies targeting biofilm-associated infections is crucial. Further data are needed on the long-term use of suppressive antibiotic therapy. In particular, pharmacokinetic and pharmacodynamic information regarding antibiotics used in this setting remains limited.



New imaging techniques, particularly PET/CT, are currently recommended by clinical guidelines to improve diagnostic assessment and to support decisions regarding long-term oral antibiotic therapy. Further studies are warranted to evaluate the reliability of PET/CT in guiding the duration of antibiotic treatment.



The objectives of this Research Topic include:



Observational studies or clinical trials focused on antimicrobial treatment specific to bacterial species causing endocarditis (e.g., Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis).



Long-term suppressive antimicrobial therapy for endocarditis (efficacy and tolerability).



Biofilm-specific antimicrobial treatments (in vivo and in vitro data).



Pharmacokinetics and pharmacodynamics of antibiotics used in the treatment of infective endocarditis.



Use of PET imaging to determine the optimal timing for discontinuation of antibiotic therapy.



Application of novel microbiological techniques to guide the duration of antibiotic therapy.



Management of endocarditis in specific patient subsets, including but not limited to the elderly, individuals with renal impairment, and immunocompromised patients.