**8. Prevention and future considerations**

After analyzing the literature of IE in different regions of the world, we found different pathogens depending on the endemic regions for some pathologies, for example, RHD, usage of antibiotic treatment before having a diagnosis, endemic zones for rare pathogens such as *Brucella* spp. in Turkey or even zoonosis reported by Watt et al. [7, 16, 20].

One of the recommendations for developing countries must be an adequate treatment and follow-up for group A beta-hemolytic streptococcus to prevent rheumatic fever and its cardiac complications, which is one of the most common causes of IE in general population and in HD 19 patients in developing countries [16].

There are many different scenarios between developed and developing countries, but we think that the security measures for prevention of bacteremia in HD can be achieved in any health care unit using HD program regardless of the place. Reducing bacteremia in HD patients will reduce their incidence of IE [16].

Pronovost et al. in their study made in 103 UCIs in Michigan used basic changes in their practice of catheter implantation and management. An evidence-based intervention resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period [29].
