A multidisciplinary approach to infective endocarditis: diagnosis, medical and surgical management

Infective endocarditis is a severe multiorgan disease with high lethality, the epidemiological profile of which is being transformed by an ageing population, the increasing use of valve prostheses and implantable cardiac devices, and the spread of intravenous drug use. This review presents updated data on the epidemiology, pathophysiology and microbiology of the disease, the clinical presentation of right- and left-sided involvement, the diagnostic algorithm – including the revised Duke-ISCVID criteria (2023) – and the principles of antimicrobial therapy. Particular attention is given to surgical treatment: indications, optimal timing of intervention, the role of imaging in surgical decision-making, operative techniques, and choice of valve substitute, in line with the findings of recent systematic reviews and meta-analyses. Postoperative follow-up, the distinction between relapse and reinfection, and the specific therapeutic challenges in patients with intravenous drug use are also discussed. Early diagnosis and a multidisciplinary therapeutic approach remain decisive for improving prognosis in this patient population.