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Evidence review and recommendations

Patients with certain cardiac conditions are known to be at risk of developing infective endocarditis (IE) 2 The abbreviation IE for infective endocarditis will be used throughout this guideline. However, where research papers have used the term bacterial endocarditis (BE) the term used within the paper will be used when discussing it. . Guidelines and discussion on prophylaxis against IE start from the premise that it is possible to classify those with underlying cardiac conditions into those who are at increased risk and those whose risk is considered to be the same as, or little greater than, the general population. However, the stratification of patients into high-risk or low-risk groups has proved to be difficult. Steckelberg and Wilson (Steckelberg and Wilson 1993) highlighted that the degree of risk associated with specific valvular lesions cannot be directly inferred from their frequency among endocarditis patients, because the prevalence of these lesions varies widely. The arbitrary nature of some of the decisions concerning risk identification has also been discussed (Durack 1995). Nonetheless, consideration of which underlying conditions affect a person’s risk of developing IE is important because it will influence decisions made about offering prophylaxis.

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