Since the 1960s the most common causes of IE are nosocomial infections from intravenous (IV) catheters, IV drug abuse, and prosthetic valve endocarditis.

The etiology of acute IE is predominantly bacterial. The two most common causes of bacterial endocarditis are staphylococcal and streptococcal infections (Box 1), and Staphyloccus aureus is the primary pathogen of endocarditis. Subacute IE occurs in people with acquired cardiac lesions. Possible ports of entry for the infecting organism include lesions or abscesses of the skin and genitourinary (GU) or gastrointestinal (GI) infections. Surgical or invasive procedures such as tooth extraction, tonsillectomy, bronchoscopy, endoscopy, cystoscopy, and prosthetic valve replacement also place the patient at risk.

• BOX 1 Conditions Predisposing to Endocarditis

• Rheumatic heart disease

• Mitral valve prolapse

• Congenital heart disease (patent ductus

• Asymmetric septal hypertrophy

arteriosus, ventricular septal defect, bicuspid

• Marfan's syndrome

arotic valve, Fallot's tetralogy)

• Previous episodes of endocarditis

• Prosthetic valve surgery

• Skin, bone, and pulmonary infections

• Parenteral drug abuse

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