Four decades of experience of prosthetic valve endocarditis reflect a high variety of diverse pathogens

Andreas Oberbach, Nadine Schlichting, Christian Hagl, Stefanie Lehmann, Yvonne Kullnick, Maik Friedrich, Ulrike Köhl, Friedemann Horn, Vivek Kumbhari, Bettina Löffler, Frank Schmidt, Dominik Joskowiak, Frank Born, Shekhar Saha, Erik Bagaev

Research output: Contribution to journalReview articlepeer-review


Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci, and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent, and frequently, false-negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal, and viral pathogens in blood and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.

Original languageEnglish (US)
Pages (from-to)410-428
Number of pages19
JournalCardiovascular research
Issue number2
StatePublished - Feb 1 2023


  • Blood culture
  • Microbial diversity
  • Molecular diagnostic
  • Prosthetic valve endocarditis
  • Virulence

ASJC Scopus subject areas

  • General Medicine


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