Infectious Endocarditis: Skin, Mouth Are Most Frequent Portals of Entry Interview with:
François Delahaye, MD, PhD

Department of Cardiology
Hôpital Louis Pradel, Hospices Civils de Lyon
Université Claude Bernard
Lyon, France

Medical Research: What is the background for this study?

Response: Infective endocarditis (IE) is a severe disease, with an in-hospital mortality rate of about 20%. Five percent to 10% of patients will have additional episodes of IE. Thus, looking for and treating the portal of entry (POE) of IE is particularly important. The POE of the present episode must be identified in order to treat it. The potential POE of a new episode must be searched for in order to eradicate it and thus lower the risk for a new IE episode. Yet published research on this topic is nonexistent. The search for and treatment of the POE are not even mentioned in the guidelines on IE. We thus undertook a study of the performance of a systematic search for the portal of entry of the present episode of IE and of a potential new episode of Infective endocarditis.

Patients were systematically seen by a stomatologist, an ear, nose, and throat specialist, and a urologist; women were systematically seen by a gynecologist; patients were seen by a dermatologist when there were cutaneous and/or mucous lesions. Colonoscopy and gastroscopy were performed if the microorganism came from the gastrointestinal tract in patients ≥ 50 years of age and in those with familial histories of colonic polyposis. Treatment of the portal of entry was systematically considered.

Medical Research: What are the main findings?

Response: The POEs of the present Infective endocarditis episodes were identified in 74% of the 318 included patients. The most frequent portal of entry was cutaneous (40% of identified POEs). It was mainly (62% of cutaneous POEs) associated with health care and with intravenous drug use. The second most frequent POE was oral or dental (29%). A dental infectious focus was more often involved (59% of oral or dental POEs) than a dental procedure (12%). POEs were gastrointestinal in 23% of patients. Colonic polyps were found in one-half of the patients and colorectal adenocarcinomas in 14%. Performance was good regarding the search for an oral or dental or a colonic potential POE, which were found in 53% and 40% of patients, respectively.

Medical Research: What should clinicians and patients take away from your report?

Response: A systematic search can identify the source of bacteremia in three-quarters of patients with Infective endocarditis, and in more than one-third of cases, additional potential POEs can be found that pose a risk for future infections.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Additional studies could be conducted to confirm these findings and assess the efficacy of eradicating potential portals of bacterial entry for the prevention of recurrent endocarditis.


Delahaye F, M’Hammedi A, Guerpillon B, et al. Systematic Search for Present and Potential Portals of Entry for Infective Endocarditis. J Am Coll Cardiol. 2016;67(2):151-158. doi:10.1016/j.jacc.2015.10.065.

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François Delahaye, MD, PhD (2016). Infectious Endocarditis: Skin, Mouth Are Most Frequent Portals of Entry