Despite the emergence of molecular research methods, the diagnosis of infectious endocarditis (IE) is difficult and mortality remains high (21-35%). The incidence continues to increase, reaching 3.3 cases per 100,000 population per year in the United Kingdom and the United States and 1.4 to 4.0 per 100,000 in Europe as a whole. The reasons are an increase in the life expectancy of patients with degenerative heart disease, more frequent use of antibiotics, an increase in the prevalence of prosthetic heart valves, an increase in the prevalence of congenital heart defects in young children and mitral valve malformations, the provision of conservative and surgical treatments, an increase in the number of drug addicts and a more precise diagnosis. Men are sick more often than women, most people aged 50 to 60 are sick. The spectrum of pathogens is quite wide.

Piercing or threading jewelry through holes in the eyebrows, atria, lips, tongue, nose, navel, nipples or genitals is becoming more common in developed countries. A study of students from New York in 2002 found that 42% of men and 60% of women used a piercing procedure.

Piercing can lead to speech impairment, damage to subcutaneous structures, but the most common complication is a local inflammatory process.

Infectious endocarditis associated with piercing is rare in the general population, but is much more common in people with concomitant heart disease. An increase in the frequency of these cases has been observed over the past decade. During the period 1991-1999. 3 cases have been recorded, and in the past 2 years - 5 cases. Most patients had concomitant heart disease. In these patients, the tongue was most often pierced, less often the ear, nose, navel or nipple. The average age was 20 years, men and women were also often sick. The disease usually started about a month after the piercing procedure. The responsible agents were S.aureus, S.epidermidis (62.5%), Neisseria spp., Haemophilus spp.. and Streptococcus spp. Adequate antibiotic therapy allowed the recovery of all patients.

An increase in the prevalence of congenital heart defects, combined with an increase in the popularity of piercings in children and youth, can lead to a significantly higher number of cases of infective endocarditis in children at risk. It should also be borne in mind that parental awareness is quite low: only 29% of parents know when antibiotic prophylaxis is needed.

Antibiotics are recommended by some national guidelines for the prevention of infectious endocarditis, but to date, none of the recommendations has described the need for antibiotic prophylaxis for piercing in patients at risk. This procedure should be considered as potentially dangerous in relation to IA disease for the following reasons: invasive nature of the procedure, there may be microorganisms causing IE in the puncture site (S.aureus on the mucous membranes, green streptococci in the oral cavity), prolonged scarring after inflicted injury (for healing the tongue - 6 weeks, on the nipple - 1 year), the procedure is performed by untrained people and in poor sanitary conditions, the formation of biofilms on threaded jewelry and the difficulty of observing hygiene at the puncture site.

Although there is no evidence that antibiotics are effective in preventing the AE associated with piercing, studies have shown that 28% of doctors in Japan and 61% of doctors in the United States recommend piercing with antibiotics. The point of view is as follows: infective endocarditis is a serious disease, and it is therefore easier to give 1 dose of an inexpensive antibiotic in prophylaxis until reliable data on the efficacy of these are obtained. measures.

Informing patients about the risk of IE related to piercing and antibiotic prophylaxis among at-risk populations is an important preventive measure for IE. Patients with congenital heart defects should be advised not to pierce to reduce the risk of IE. And if the patient still wishes to perform a similar procedure, it is necessary to recommend antibiotic prophylaxis.

Prospective studies are needed to assess the relationship between piercing and infective endocarditis to resolve the problem of antibiotic prophylaxis in these cases; it is also necessary to assess the impact of these practices on the development of resistance.