Endocarditis remains an elusive challenge for clinicians to master. As the population ages and their comorbidities increase, the risk of infecting cardiac structures - both native and, the ever-increasing use of, prosthetic support technology - also increases. In addition, the global epidemic of intravenous substance abuse has also resulted in a substantial increase in the number of infected patients. Fortunately, advances in the diagnostic testing, imaging, and recognition of the importance of a multidisciplinary management team have also contributed to advances in the care of these critically ill patients. Nevertheless, optimal therapies need to be individualized and considered in the ever-increasing body of scientific literature on this complex and difficult problem.

Introductory Chapter: Introduction to Advanced Concepts in Endocarditis.

The most important example of intravascular infection is infective endocarditis (IE), a common and serious disorder in man. In the past, these infections were uniformly fatal, but since the development of potent antimicrobial agents, bac teriological cure has become practical and predictable. So, for a while, it seemed that intravascular infection would diminish in importance and be relegated to the stockpile of illnesses which physicians, one or two generations earlier, used to see frequently. In recent years, however, spectacular technological advances (cardiac surgery, intravascular devices, hemodialysis), accompanied by profound social deterioration (intravenous drug usage), have provided new breeding grounds for the development of these infections. So it is that a large percentage of intravascular infections may be looked upon today as one of the diseases of medical progress and social evolution. This "progress," however, has not only contributed to the encouragement of the disease; there is another side to the coin: the same technological advances that have served to increase the frequency of infection (e. g. , intravascular plastic catheters) have also led to the first simple, easily reproducible laboratory animal model for the study of the disease, thus advancing our understanding of the prophylaxis, treatment, and general biology of these infections (Figures 1 and 2). Similarly, whereas the insertion of prosthetic heart valves has created a new group of patients with endocarditis, these same surgical techniques are lifesaving to patients with endocarditis whose aortic valves have perforated.

This reference resource represents the consensus opinion a team of international specialists on the diagnosis and treatment of infective endocarditis (IE), many of whom have been co-authors of American or European guidelines on the topic. It is therefore a useful tool for many practitioners: cardiologists and cardiac imagers, cardiac surgeons, echocardiographers, specialists of internal medicine, neurologists, and infectiologists. ​​​Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect. Its intracardiac effects include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial abscesses. If left untreated, IE is generally fatal. IE is a changing disease with new diagnostic techniques, new therapeutic strategies, more frequent elderly people and patients with prosthetic valves of intravenous drug users.

Now in paperback, the second edition of the Oxford Textbook of Critical Care is a comprehensive multi-disciplinary text covering all aspects of adult intensive care management. Uniquely this text takes a problem-orientated approach providing a key resource for daily clinical issues in the intensive care unit. The text is organized into short topics allowing readers to rapidly access authoritative information on specific clinical problems. Each topic refers to basic physiological principles and provides up-to-date treatment advice supported by references to the most vital literature. Where international differences exist in clinical practice, authors cover alternative views. Key messages summarise each topic in order to aid quick review and decision making. Edited and written by an international group of recognized experts from many disciplines, the second edition of the Oxford Textbook of Critical Careprovides an up-to-date reference that is relevant for intensive care units and emergency departments globally. This volume is the definitive text for all health care providers, including physicians, nurses, respiratory therapists, and other allied health professionals who take care of critically ill patients.