2023-08-31 11:38:16
New Guidelines Released for the Prevention, Diagnosis, and Treatment of Infective Endocarditis
Amsterdam – The European Society of Cardiology (ESC) has recently published new guidelines for the prevention, diagnosis, and treatment of infective endocarditis (IE), a rare and potentially fatal infection of the heart’s lining and valves. These updated guidelines, which are an improved version of the previous 2015 guidelines, were necessitated by advancements in imaging techniques and a study on antibiotic prophylaxis.
The guidelines were discussed by the co-chairs of the working group, Dr. Victoria Delgado and Dr. Michael A. Borger, along with other experts, during three sessions at the ESC Congress 2023. The recommendations were also published in the European Heart Journal.
According to Dr. Borger, diagnosing endocarditis can be challenging due to the various clinical scenarios it presents. He emphasized the importance of early diagnosis and treatment for this rare but potentially deadly disease. The new guidelines include four key points:
1. Higher recommendation grade and clearer definition of prevention and prophylaxis of endocarditis in higher-risk patients.
2. Increased role of noncardiographic cardiac imaging techniques in the diagnosis of endocarditis.
3. More precisely defined indications and timing for surgical interventions, along with several new surgical recommendations.
4. More precise criteria for the diagnosis and treatment of endocarditis associated with electronic cardiac implants.
Patients with a history of previous endocarditis, surgically implanted prosthetic heart valves, certain congenital heart diseases, operations with prosthetic material, or cardiac assist devices are at high risk of IE. The guidelines recommend giving them prophylactic antibiotics before oral or dental procedures. Patients with other heart conditions are classified as intermediate risk and need to be evaluated on a case-by-case basis.
The advancements in imaging methods have made it necessary to revise the endocarditis guidelines. Diagnosis of IE now requires meeting specific criteria, including positive blood cultures, positive imaging for IE through echocardiography or cardiac computed tomography, and specific secondary criteria.
Dr. Delgado emphasized the importance of patient education for early diagnosis and prevention. Patients with heart valve disease or previous heart valve surgery need to be vigilant about symptoms and preventive measures. The guidelines include recommendations for good dental hygiene, avoiding risky procedures like tattoos and piercings, and prompt treatment of skin wounds.
The guidelines also highlight the results of the POET study, which showed that oral outpatient antibiotic therapy is statistically significantly better than inpatient intravenous therapy for certain stable patients with endocarditis. This finding has significant implications for the care of patients with this life-threatening condition.
Additionally, the guidelines emphasize the importance of timely surgical intervention once there is an indication for heart surgery. The guidelines categorize surgical indications as emergency, urgent, or non-urgent, and stress the need for prompt surgery to improve patients’ chances of survival.
These new guidelines aim to improve the prevention, diagnosis, and treatment of infective endocarditis. The ESC hopes that these advancements will lead to better outcomes for patients with this rare but potentially deadly condition.]
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