Should we include microorganisms in scores to predict outcome in candidates for cardiac surgery during the acute phase of endocarditis?

Infective endocarditis (IE) is a complex disease, at the crossroad of a large number of medical specialties, including cardiology, infectious diseases, internal medicine, neurology, intensive care, microbiology, and radiology (1,2). In addition, cardiac surgeons have been increasingly involved, as 60–70% of patients with IE present theoretical indication(s) for cardiac surgery (3). The selection of patients in whom cardiac surgery must be performed during the acute phase of IE is among the most difficult medical decisions in contemporary medicine, as both the benefits and the risks are high. Indeed, the strategy that will be finally selected, in agreement with other colleagues, the patient, and/or his relatives, may be a major determinant of whether the patient will die, or survive, with or without impairment of their quality of life.