Infective endocarditis (IE) is a relatively rare but potentially life-threatening disease characterized by substantial mortality and long-term sequelae among the survivors. In recent decades, a dramatic change in the profile of patients diagnosed with IE has been observed primarily in developed countries, most likely due to an aging population and a recent increase in invasive medical procedures. Nowadays, the typical IE patient is usually older, with complex comorbidities, and a history significant for cardiac disease, including degenerative heart valve disease, prosthetic valves, or cardiovascular implantable electronic devices (CIEDs). Moreover, as patient risk factors change, predisposing them to more healthcare-associated IE, the microbiology of IE is also shifting; there are growing concerns regarding the rise in the incidence of IE caused by difficult-to-treat resistance (DTR) bacteria in at-risk patients with frequent healthcare contact. The present review aims to explore the evolving landscape of IE and summarize the current knowledge on novel diagnostics to ensure timely diagnosis and outline optimal therapy for DTR bacterial IE.

Since its first description in the late nineteenth century, the epidemiology of infective endocarditis (IE) has changed considerably. Once primarily affecting younger individuals with structural heart disease, IE is now increasingly encountered in older patients with multiple comorbidities and frequent healthcare exposure. Population ageing, end-stage renal disease (ESRD), immunosuppression, and injection drug use (IDU) have broadened the pool of susceptible hosts. At the same time, the increasing use of prosthetic valves (PVs), cardiac implantable electronic devices (CIEDs), and transcatheter cardiac interventions has reshaped the clinical spectrum of IE. This epidemiological transition has also been accompanied by shifts in microbiological patterns, with a growing predominance of staphylococci and enterococci, as well as marked geographic and socioeconomic variation in disease burden. This review summarizes the contemporary epidemiology of IE, with an emphasis on the host-, healthcare-, and microbiological factors underlying its evolving clinical profile.