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The term IE is defined as a microbial infection of the heart valve (native or prosthetic) or the mural endocardium leading to tissue destruction and vegetation. Patients with cardiac abnormalities along with bacterial exposure (from trauma or other sources) leading to transient bacteraemia, are generally affected [1,2]. The diagnosis is made with the help of clinical manifestations, laboratory findings and imaging techniques (CT, MRI, Transoesophageal echocardiography). Clinical and laboratory findings include fever, elevated inflammatory markers, embolic phenomenon, heart murmurs, vascular and immunological phenomenon (splinter haemorrhages osler’s node, Roth spots, glomerulonephritis), elevated bilirubin, thrombocytopenia and lactataemia [1-4]. In the update on IE by Bashore TM et al., microbiological spectrum analysis showed that majority of the cases were caused by Staphylococci (coagulase negative staphylococci, S. aureus) and Streptococci (viridans streptococci). Minority cases were caused by Enterococci. The remaining few infections were caused by gram negative species, Candida species and MRSA [5], though the number is increasing recently due to prolonged hospitalisation, in-situ catheters and increase in lifestyle disease like diabetes. There were a sizeable number of culture negative cases as well [5]. The incidence of IE is found to be between 2 and 6 per 100,000 individuals per year, and that of associated mortality to be between 10% and 30%. Factors that affect mortality are type of pathogen, the underlying condition, and whether the infection is due to native or prosthetic heart valve [6-8]. The predisposing risk factors behind endocarditis are: history of rheumatic fever or rheumatic heart disease, prosthetic heart valve, congenital heart defect, previous cardiac surgery, history of IE, history of intravenous drug use and dental procedures [8,9]. In patients at a risk of IE, antibiotics should be taken before dental and certain surgical procedures such as lung surgery, surgery on infected skin, bone or muscle tissue and before any biopsy [9,10]. The new guidelines recommend prophylactic antibiotics in conditions that are associated with the highest probability of risk of IE (i.e., patients with prosthetic heart valve, congenital heart disease, previous IE and patients who develop cardiac valvulopathy after cardiac transplant) [6,8,11-13].

A Prospective Study to Analyse the Agreement between Empirical Antimicrobials used in Infective Endocarditis and Culture Sensitivity Reports