Methods:

Patients with definite IE at a single tertiary hospital in France were prospectively enrolled since 2005 in a study that sought to identify the point of entry of the organism responsible for IE, and sites that might serve as points of entry for future episodes of IE. Apparently without requiring informed consent, all patients were evaluated by a stomatologist (a specialist in oral medicine, presumably including specialties of dental medicine and oral and maxillofacial medicine) with a rotational panoramic dental x-ray; an ear, nose, and throat specialist; a urologist; a gynecologist if female; and a dermatologist if there were cutaneous or periorifice lesions. All patients underwent cerebral and thoraco-abdomino-pelvic scans; and colonoscopy and gastroscopy were performed if micro-organisms were thought to be of gastrointestinal origin and patients either were ≥50 years old or there was a family history of colonic polyposis. For each micro-organism, the most likely point of entry was inferred from its natural habitat or by literature-based determination of its site of colonization in humans.