Background and introduction
Topic | Recommendations in ESC guidelines | Recommendation by the working group |
---|---|---|
Antibiotic prophylaxis | Reserve antibiotic prophylaxis for high-risk individuals undergoing dental procedures | No change or comment by the working group |
Prevention of infection before cardiac or vascular interventions | Screen every patient and treat Staphylococcus aureus carriers only pre-operatively | Pre-operative screening and/or treatment of nasal carriage of Staphylococcus aureus is recommended before elective surgery in order to treat carriersa |
Microbiological diagnosis | Use the recommendation as presented in the ESC guidelines | Use flowchart as presented in Fig. 1 a |
Diagnostic imaging and criteria | Use diagnostic ESC criteria and the recommendation presented in the guidelines | Use diagnostic ESC criteria and the flowchart as presented in Fig. 2 a |
Endocarditis team | Centres without cardio-thoracic facilities must consult the regional endocarditis team in cases of (suspected) IE | No change or comment by the working group |
Antimicrobial therapy | Antimicrobial therapy according to the ESC guidelines | Antimicrobial therapy according to SWAB guidelinesa |
Surgery | Indication and timing of surgery as presented in the guidelines | No change or comment for the indication of surgery Timing of surgery determined by the specialists involveda |
Discharge | Transthoracic echo after completion of therapy Regular follow-up including blood samples Good oral health maintenance | No change or comment by the working group |
Prevention and prophylaxis
Microbiological diagnosis
Diagnostic imaging and criteria
Major criteria |
1. Blood cultures positive for IE a. Typical micro-organisms consistent with IE from 2 separate blood cultures: – Viridans streptococci, Streptococcus gallolyticus (Streptococcus bovis), HACEK groupa, Staphylococcus aureus; or – Community-acquired enterococci, in the absence of a primary focus; or b. Micro-organisms consistent with IE from persistently positive blood cultures: – ≥2 positive blood cultures of blood samples drawn >12 h apart; or – All of 3 or a majority of ≥4 separate cultures of blood (with first and last samples drawn ≥1 h apart); or c. Coxiella burnetii phase I IgG antibody titre >1:1024 |
2. Imaging positive for IE a. Echocardiogram positive for IE: – Vegetation – Abscess, pseudoaneurysm, intracardiac fistula – Valvular perforation or aneurysm – New partial dehiscence of prosthetic valve b. Abnormal activity around the site of prosthetic valve implantation detected by 18F‑FDG PET/CT (only if the prosthesis was implanted for >3 months) c. Paravalvular lesions and/or vegetation detected by cardiac CTA |
Minor criteria |
1. Predisposing heart condition or injection drug use 2. Fever defined as temperature >38 °C 3. Vascular phenomena (including those detected by imaging only) 4. Immunological phenomena (e.g. Janeway lesions, Osler’s nodes) 5. Positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with IE |
Definite IE – Clinical criteria: 2 major or 1 major +3 minor or 5 minor criteria – Pathological criteria: microorganism cultures from the vegetation or confirmed by histological examination of vegetation/intra-cardiac abscess showing active endocarditis Possible IE – Clinical criteria: 1 major +1 minor or 3 minor criteria |