**5. Prevention**

Fungal endocarditis may be caused by endogenous or exogenous fungi. The prevention of FE could be through adopting two strategies; one is general and useful for all infections like hand-washing, personal hygiene, and indwelling central venous catheters care, and the other is especially for fungal infections. Practical ways to achieve this goal is use of nondrug or drug prevention (prophylaxis). Avoiding opportunistic endogenous agents like *Candida* spp. which colonize in the human body sites is difficult. The best strategy for the management of *Candida* endocarditis is the evaluation of colonization pre-surgery to determine the susceptibility pattern of the isolated organisms, which may cause infection after surgery and enhance the success of management of systemic or endocarditis candidiasis. Care of central venous catheters is important for reducing candidemia and *Candida* endocarditis; and the removal of all existing central venous catheters for the reduction of morbidity and mortality (106-108) is helpful. However, in patients with obligate central venous access, new sites should be obtained (109, 110).

Fungal spores are abundant in the environment, and unfiltered air, dust, and contaminated materials are full of fungal conidia (111, 112). In many cases, fungal infections may occur during the surgery, via contaminated air, surgical site or equipment with conidia. To prevent the contamination, use of high-efficiency particulate air filters for air sterility (113), and sterile equipment in the operation room are recommended.

Antifungal prophylaxis could be used to avoid the development of fungal infections in high risk patients (114), based on the susceptibility patterns of the etiologic agents in each region. Empiric therapy (antifungal treatment of febrile patients at risk for infections) was first introduced to prevent invasive fungal infections in the 1980s in patients with undiagnosed fevers, particularly invasive candidiasis (115). To prevent the relapse in patients with history of fungal infections who have received complete antifungal therapy, clinicians can turn to secondary prophylaxis.
