Risk factors for IE.
| Category | Risk factor | Details/Examples |
|---|---|---|
| Patient-related | Previous history of IE | Strongest risk factor |
| Structural heart disease | Rheumatic heart disease, bicuspid aortic valve, mitral valve prolapse with regurgitation | |
| CHD | Cyanotic CHD, unrepaired defects, or repaired with prosthetic material | |
| Intravenous drug use | Strong association with right-sided IE | |
| Immunosuppression | Due to chemotherapy, HIV, immunosuppressive drugs | |
| Diabetes mellitus | Increased susceptibility for IE | |
| Chronic hemodialysis | Due to frequent vascular access | |
| Indwelling vascular catheters | Central lines, PICC lines | |
| Poor dentition or recent dental infection | Risk via oral flora | |
| Advanced age | Age-related degeneration of valves, comorbidities | |
| Liver disease | Especially cirrhosis | |
| Malignancy | Especially GI or genitourinary cancers | |
| Nosocomial exposure | Hospital-acquired bacteremia | |
| Valve/Device-related | Prosthetic heart valve (mechanical or bioprosthetic) | Risk highest in first year post-implantation (< 60 days) |
| Transcatheter valve | Similar early risk to surgical valves, unique microbiology | |
| Native valve disease | Mitral and aortic valves most affected | |
| Valve dysfunction | Regurgitation and/or stenosis | |
| Presence of intracardiac devices | Pacemakers, ICDs, CRT devices | |
| Annular calcification | Associated with increased risk | |
| Previous valve surgery | Residual suture lines or patches may harbor infection | |
| Procedure-related | Dental procedures | Manipulation of gingiva or perforation of oral mucosa |
| Respiratory tract procedures | Bronchoscopy with biopsy, tonsillectomy | |
| GI or genitourinary procedures | Especially in patients with active infection | |
| Invasive cardiac procedures | TAVR, pacemaker/ICD implantation, ablation | |
| Vascular catheter manipulation | Hemodialysis access, central line placement | |
| Non-sterile injection practices | Common in IV drug use | |
| Inadequate perioperative prophylaxis | Especially in high-risk individuals |
IE: infective endocarditis; CHD: congenital heart disease; HIV: human immunodeficiency virus; PICC: peripherally inserted central catheter; GI: gastrointestinal; ICDs: implantable cardioverter defibrillators; CRT: cardiac resynchronization therapy; TAVR: transcatheter aortic valve replacement; IV: intravenous.
TC: Investigation, Writing—original draft, Writing—review & editing. JER: Investigation, Writing—review & editing, Visualization. SLPV: Writing—review & editing, Validation. TKMW: Conceptualization, Supervision, Writing—review & editing, Project administration. All authors read and approved the final manuscript.
The authors declare that they have no conflicts of interest.
Ethical approval is not required for a review study according to the local Ethics Committee.
Informed consent to participate is not required for a review study according to the local Ethics Committee.
Not applicable.
All relevant data is contained within the manuscript.
Not applicable.
© The Author(s) 2025.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.