ESC infective endocarditis guidelines boost role of imaging in diagnosis

August 29, 2015

London, UK - 29 Aug 2015: ESC Guidelines published today on infective endocarditis boost the role of imaging in diagnosis of this deadly disease.

"We emphasise the need for a multimodality imaging approach to diagnosing endocarditis," said Professor Gilbert Habib, Chairperson of the guidelines Task Force. "While the 2009 guidelines1 focused on echocardiography, the 2015 guidelines show the important role of other imaging techniques such as PET-CT. These new imaging techniques are increasingly useful for the diagnosis and management of infective endocarditis and we recommend their use in a novel ESC diagnostic algorithm."

The ESC Guidelines for the management of infective endocarditis are published today online in European Heart Journal2 and on the ESC Website.

For the first time, the guidelines recommend that an endocarditis team operating in a reference centre is crucial for the management of infective endocarditis. The team should include cardiologists, cardiac surgeons and specialists in infectious diseases, while reference centres should have immediate access to diagnostic procedures and cardiac surgery.

"A multidisciplinary approach is mandatory for the treatment of patients with infective endocarditis," said Professor Habib. "In our centre we showed that this approach dramatically reduced one year mortality in patients with infective endocarditis from 18.5% to 8.2%. Management by an endocarditis team in a reference centre is one of the most important new recommendations."

Also new are recommendations for specific situations including infective endocarditis in the intensive care unit, infective endocarditis associated with cancer, and marantic (non-bacterial) infective endocarditis.

Important recommendations are given for the combination of early diagnosis, early antibiotic therapy and early surgery. "Endocarditis is a deadly disease if treated too late," said Professor Patrizio Lancellotti, co-Chairperson of the Task Force. "The new guidelines focus on methods to reduce delays in diagnosis, early introduction of antibiotics, and sending patients to a surgeon very early. The 2009 guidelines were the first to introduce the concept of optimal timing of surgery in patients with infective endocarditis and this is highlighted again in 2015."

Antibiotic prophylaxis was a controversial area of discussion by the guidelines Task Force. One of the main changes in the 2009 guidelines was the reduction of prophylaxis because there was no real scientific proof of its efficacy and it may be potentially dangerous. Thus, antibiotic prophylaxis was recommended only for patients with the highest risk of infective endocarditis undergoing the highest risk dental procedures. Similar changes were proposed by the American guidelines. Good oral hygiene and regular dental review were considered to have a more important role in reducing the risk of infective endocarditis.

Professor Habib said: "Recent publications have underlined the risk of increasing incidence of infective endocarditis since the previous guidelines, suspected to be related to the reduced antibiotic prophylaxis. However, the evidence was considered by the Task Force to be too low to modify the 2009 guidelines. Therefore the present guidelines continue to recommend antibiotic prophylaxis only for patients at the highest risk. Studies, ideally randomised, are needed to answer this very difficult question."

Antibiotic therapy was another controversial topic, with new antibiotic strategies recommended to treat staphylococcal endocarditis. Professor Lancellotti said: "A consensus was difficult to obtain in this particular subgroup of patients with the most severe form of infective endocarditis. Ongoing studies on this topic will be useful."

Professor Habib concluded: "Endocarditis is a changing disease that is still associated with a high mortality (10-26% in-hospital mortality). We hope the new guidelines will help physicians to focus on prevention rather than prophylaxis to reduce the incidence of infective endocarditis, particularly in the field of nosocomial (hospital-acquired) endocarditis. Mortality can be reduced by multidisciplinary management in endocarditis centres. And we urge physicians to send patients with infective endocarditis for early surgical assessment as soon as possible."
-end-


European Society of Cardiology

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.