implementationofthe2015europeansocietyofcardiology ... · 2020. 11. 23. · european society of...

Review Article

Neth Heart J (2020) 28:628–636https://doi.org/10.1007/s12471-020-01489-9

Implementation of the 2015 European Society of Cardiologyguidelines for themanagement of infective endocarditis inthe Netherlands

A. R. Wahadat · J. W. Deckers · R. P. J. Budde · J. T. M. van der Meer · E. H. Natour · J. ten Oever ·A. L. J. Kortlever-van der Spek · B. H. Stegeman · N. J. Verkaik · J. W. Roos-Hesselink · W. Tanis

Published online: 9 September 2020© The Author(s) 2020

Abstract Because the occurrence of infective endo-carditis (IE) continues to be associated with high mor-tality, a working group was created by the Dutch So-ciety of Cardiology to examine how the most recentEuropean Society of Cardiology (ESC) guidelines forIE management could be implemented most effec-tively in the Netherlands. In order to investigate cur-rent Dutch IE practices, the working group conducteda country-wide survey. Based on the results obtained,it was concluded that most ESC recommendationscould be endorsed, albeit with some adjustments. Forinstance, the suggested pre-operative screening andtreatment of nasal carriers of Staphylococcus aureusas formulated in the ESC guideline was found to bedissimilar to current Dutch practice, and was there-fore made less restrictive. The recently adapted ESCdiagnostic criteria for IE were endorsed, while thepractical employment of the relevant diagnostic tech-niques was simplified in an adapted flowchart. In ad-dition, the presence of a multidisciplinary, so-called‘endocarditis team’ in tertiary centres was proposed asa quality indicator. An adapted flowchart specifically

A. R. Wahadat · J. W. Deckers · R. P. J. Budde (�) ·J. W. Roos-HesselinkDepartment of Cardiology, Thoraxcenter, Erasmus MedicalCentre, Rotterdam, The [email protected]

A. R. Wahadat · R. P. J. BuddeDepartment of Radiology and Nuclear Medicine, ErasmusMedical Centre, Rotterdam, The Netherlands

A. R. Wahadat · W. TanisDepartment of Cardiology, Haga Teaching Hospital, TheHague, The Netherlands

J. T. M. van der MeerDepartment of Internal Medicine and Infectious Diseases,AmsterdamUMC, location AMC, Amsterdam, TheNetherlands

tailored to Dutch practice for microbiological diag-nostic purposes was constructed. Lastly, the workinggroup recommended the Stichting Werkgroep Antibi-oticabeleid (SWAB; Dutch Working Party on AntibioticPolicy) guidelines for IE treatment instead of the an-tibiotic regimens proposed by the ESC.

Keywords Infective endocarditis · Microbiologicaldiagnosis · Disease management · Cardiac imaging ·Infection · Prosthetic heart valves

Background and introduction

One of the oldest cardiac diseases, infective endo-carditis (IE), remains one of the most fatal mani-festations of heart disease [1]. Despite considerableprogress in diagnosis and treatment, the in-hospitalmortality of IE continues to be about 20%, essentiallyunchanged during the past decades [2].

The importance of IE is reflected in the frequentpublication of new guidelines, for instance by the

E. H. NatourDepartment of Thoracic Surgery, Maastricht UniversityMedical Centre, Maastricht, The Netherlands

J. ten OeverDepartment of Internal Medicine and Radboud Centre forInfectious diseases, Radboud University Medical Centre,Nijmegen, The Netherlands

A. L. J. Kortlever-van der Spek · B. H. StegemanKnowledge Institute of the Federation of Medical Specialists,Utrecht, The Netherlands

N. J. VerkaikDepartment of Medical Microbiology and InfectiousDiseases, Erasmus Medical Centre, Rotterdam, TheNetherlands

628 Implementation of the 2015 European Society of Cardiology guidelines

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Table 1 Selection of recommendations by the working group with regard to the European Society of Cardiology (ESC)guidelines. SWAB Stichting Werkgroep Antibioticabeleid (Dutch Working Party on Antibiotic Policy)

Topic Recommendations in ESC guidelines Recommendation by the working group

Antibiotic prophylaxis Reserve antibiotic prophylaxis for high-risk individu-als undergoing dental procedures

No change or comment by the working group

Prevention of infection beforecardiac or vascular interven-tions

Screen every patient and treat Staphylococcus aureuscarriers only pre-operatively

Pre-operative screening and/or treatment of nasal carriage ofStaphylococcus aureus is recommended before elective surgeryin order to treat carriersa

Microbiological diagnosis Use the recommendation as presented in the ESCguidelines

Use flowchart as presented in Fig. 1 a

Diagnostic imaging and criteria Use diagnostic ESC criteria and the recommendationpresented in the guidelines

Use diagnostic ESC criteria and the flowchart as presented inFig. 2 a

Endocarditis team Centres without cardio-thoracic facilities must con-sult the regional endocarditis team in cases of (sus-pected) IE


Antimicrobial therapy Antimicrobial therapy according to the ESC guidelines Antimicrobial therapy according to SWAB guidelinesa

Surgery Indication and timing of surgery as presented in theguidelines

No change or comment for the indication of surgeryTiming of surgery determined by the specialists involveda

Discharge Transthoracic echo after completion of therapyRegular follow-up including blood samplesGood oral health maintenance


aDifferent recommendation made by the working group compared with the ESC guidelines

European Society of Cardiology (ESC) [1]. In 2017,the Dutch Society of Cardiology created a workinggroup—funded by the Quality Foundation of theDutch Medical Specialists (SKMS)—to investigatewhether and how the recommendations summarisedin the most recent ESC guidelines on IE could beimplemented most effectively in the Netherlands. Toinvestigate current Dutch IE practices, the workinggroup conducted a short country-wide survey. Themedical topics raised in the survey are presentedin Tab. 1. This report summarises the findings andrecommendations of the working group.

Prevention and prophylaxis

Although widespread antibiotic prophylaxis for IE haslong been considered effective, the policy for liberaluse of antibiotic prophylaxis has gradually changed tomore restricted indications. Of note, the 2008 guide-lines of the National Institute of Health and ClinicalExcellence (NICE) from the UK recommended that an-tibiotic prophylaxis should be abandoned completely[3]. However, this recommendation was revised af-ter a patient with aortic valve prosthesis died fromIE after undergoing a dental procedure without—inline with the NICE guidelines—the use of prophylaxis.The NICE guidelines from 2016 recommend dentiststo inform the patient about the level of risk and lethim or her decide whether or not to receive antibi-otic prophylaxis [4]. The strategy currently endorsedby the American College of Cardiology (ACC), Ameri-can Heart Association (AHA) and ESC reserves antibi-otic prophylaxis for individuals with cardiac disease athigh risk of IE, e.g. for patients with a prosthetic valve,a history of IE, or with cyanotic congenital heart dis-ease undergoing a dental procedure with a high risk ofbacteraemia (usually involving perforation of the gin-

giva) [1, 5]. Of course, proper oral hygiene is stronglypromoted universally. The working group decided toendorse the recommendations of the ESC guidelineson prophylaxis in high-risk subjects without changesor comments [1].

Nasal carriers of Staphylococcus aureus have moreinfections after cardiac surgery [6], and the pre-oper-ative eradication of this micro-organism is thus im-portant. To this end, two options are available. Inthe first, all subjects—without additional testing—aretreated locally with an antibiotic ointment, usuallymupirocin. Another option is to screen every patient,and to treat S. aureus carriers only. The ESC guide-lines recommend only the latter procedure. But themerits of the two methods are of course compara-ble, and this is—according to the survey—reflectedby the concomitant use of both approaches for de-colonisation of S. aureus in Dutch hospitals. There-fore, the text of the recommendation in Tab. 7 of theguidelines was (slightly) adapted as follows: ‘Preop-erative screening and/or treatment of nasal carriageof Staphylococcus aureus is recommended before elec-tive cardiac surgery in order to treat carriers’, whilethe last recommendation of the same table (‘Systemiclocal treatment without screening of Staphylococcusaureus’ is not recommended) was deleted.

Microbiological diagnosis

Positive blood cultures remain the cornerstone of IEdiagnosis. At least three sets with sufficient volumeshould be taken at 30-min intervals, and samplingpreferably be obtained from a peripheral vein. Whenamicro-organism has been identified and appropriateantimicrobial treatment is commenced based on sus-ceptibility results, blood cultures should be repeatedevery 48–72h until blood cultures remain sterile to

Implementation of the 2015 European Society of Cardiology guidelines 631

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verify the effectiveness of the therapeutic regimen.Blood-culture-negative IE refers to IE in which nocausative micro-organism can be identified usingstandard culture methods. In such instances, bacteriasuch as Bartonella spp. or Coxiella burnetii, fungi orfastidious bacteria may be in play and additional di-agnostic testing may be required. Table 12 and Fig. 2in the ESC guidelines refer to these circumstances.However, some microbiological tests included thereinare not available in the Netherlands. The workinggroup has therefore developed a flowchart adapted toDutch practice (Fig. 1).

Fig. 1 Flowchart of micro-biological tests for infectiveendocarditis in The Nether-lands. IE Infective endo-carditis, BC blood cultures,SWAB Stichting WerkgroepAntibiotica Beleid (DutchWorking Party on AntibioticPolicy), PCR polymerasechain reaction. aIf the di-agnostic test is not avail-able, send the blood sam-ples and/or blood culturesto a reference laboratory.bSo as not to miss Cutibac-terium acnes and/or if bloodcultures were drawn whilereceiving antimicrobial ther-apy. cBartonella spp. (IgM,IgG), Coxiella burnetii (in-cluding indirect immunoflu-orescent assay phase I IgG),Legionella spp. (IgM, IgG),Mycoplasma spp. (IgM,IgG). dSpecific PCRs: Bar-tonella spp., Coxiella bur-netii, Legionella spp., My-coplasma spp., Tropherymawhipplei

Clinical suspicion of IE

BC (3 sets with 30-min interval)Antibiotics (SWAB guidelines 2019)

No further diagnostic tests for IE

Do the followingᵃ: Switch to therapy for BC-negative IEBC incubation up to 14 daysᵇDo serology ͨOn indication: Brucella spp. serology and/or mycobacterial blood cultures. Specific PCRs ͩ on blood (and consider 16S PCR)16S PCR, Specific PCRs ͩ and 18S PCR on surgical materialHistological test (marantic endocarditis?)Inoculate the BC bottles after incubation on agar plates

No further diagnostic tests for IEConsult endocarditis team if necessary

Treat according to susceptibility and SWAB

guidelines 2019

PositiveNegative (≥3

days) and high suspicion

Negative

BC results

Negative and low suspicion

Micro-organism? Positive

Micro-organism?

Diagnostic imaging and criteria

While the modified Duke criteria, which rely heavilyon positive blood cultures and findings compatiblewith IE at echocardiography [7], remain the mainstayfor diagnosing IE, current guidelines reflect the in-creasing importance of more advanced imaging tech-niques [1]. In particular, computed tomography (CT),positron emission tomography with CT (PET-CT)and magnetic resonance imaging have emerged asvaluable additional imaging techniques that providecomplementary diagnostic information to echocar-


Review Article

diography [1]. Available data—also from the Nether-lands—indicate increased diagnostic accuracy whenthese techniques are added to the modified Dukecriteria, especially in prosthetic valve endocarditis(PVE) [8–10]. The guidelines provide detailed recom-mendations on the use of various imaging techniquesin both native valve IE and PVE, as well in the di-agnosis of cardiac-device-related endocarditis [7, 8].The working group has combined the text and fig-ures that describe these recommendations in the ESCguidelines into a single scheme (Fig. 2).

The diagnostic accuracy of the modified Duke cri-teria—which merge the presence of an infective syn-drome and endocardial involvement, classically em-ploying echocardiography—is only moderate, in par-

Fig. 2 Flowchart of di-agnostic imaging for in-fective endocarditis in theNetherlands. IE infectiveendocarditis, TTE transtho-racic echocardiogram, TEEtransoesophageal echocar-diogram,BC blood cultures,18F-FDG PET/CT 18F-flu-orodeoxyglucose positronemission tomography com-puted tomography,SPECT single photon emis-sion computed tomogra-phy, CTA computed tomog-raphy angiography, ICE in-tracardiac echocardiogram,SWAB Stichting WerkgroepAntibiotica Beleid (DutchWorking Party on Antibi-otic Policy). a[1, 25]. b[26].cConsider referring to a ter-tiary referral centre whenthere is definite IE and oneor more of the following:congenital heart disease inpregnancy, prosthetic valveendocarditis, heart failure,perivalvular extension oruncontrolled infection, em-bolic events or cerebrovas-cular accident, arrhythmiaor conduction disturbances

Clinical suspicion of IE

One or more of the following steps:

Repeat TTE/TEE/BC18F-FDG PET/CT or radiolabelled leucocyteSPECT/CTCardiac CTAImaging for embolic events


Repeat TTE/TEE/BCCardiac CTAImaging for embolic events


Repeat TTE/TEE/BCConsider 18F-FDG PET/CT and/or ICEᵇ

Refer to the Endocarditis Team

No further diagnostics

Antimicrobial therapy (SWAB guidelines 2019)Indication for surgical intervention? Discuss with

endocarditis team

Modified Duke Criteriaᵃ (including TTE/TEE)

Possible IE?

Definite IE

Ongoing suspicion

of IE

Native valve

Valve type/

device?

Rejected IE

No further diagnostics

Definite IE?

No

Yes ͨ

Uncertain

Prosthetic valve

Device

ticular in IE of a prosthetic valve [1, 11, 12]. Advancedimaging techniques—as described above—may notonly be helpful in the detection of endocardial le-sions when added to echocardiography, but also inestablishing the presence of (clinically silent) vascularphenomena such as embolic events and infectiousaneurysm [13]. Acknowledging this, the most recentESC guidelines have added the identification of par-avalvular lesions by CT and, in the setting of PVE,abnormal activity near the site of the prosthesis on18F-fluorodeoxyglucose (18F-FDG) PET/CT or radiola-belled leucocyte single photon emission computedtomography (SPECT)/CT, as a ‘major’ criterion for IE.The currently applicable two major and five minorcriteria for IE are described in Tab. 2. Examples of pos-


Review Article

Table 2 Diagnostic criteria for infective endocarditis (IE)according to the 2015 European Society of Cardiology(ESC) guidelines for IE

Major criteria

1. Blood cultures positive for IEa. Typical micro-organisms consistent with IE from 2 separate blood cul-tures:– 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 bloodcultures:–≥2 positive blood cultures of blood samples drawn >12h apart; or– All of 3 or a majority of ≥4 separate cultures of blood (with first and last

samples drawn ≥1h apart); or

c. Coxiella burnetii phase I IgG antibody titre >1:1024

2. Imaging positive for IEa. 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 implantationdetected 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 use2. Fever defined as temperature >38°C3. 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 aboveor 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 con-

firmed by histological examination of vegetation/intra-cardiac abscessshowing active endocarditis

Possible IE– Clinical criteria: 1 major +1 minor or 3 minor criteria

Data partially derived from the 2015 ESC guidelines for IE [1]IE infective endocarditis, 18F-FDG 18F-fluorodeoxyglucose, PET/CT positronemission tomography/computed tomography, CTA computed tomographyangiographyaHaemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella

itive echocardiogram, 18F-FDG PET/CT and cardiacCT are demonstrated in Fig. 3.

The ‘endocarditis team’

An important addition in the latest ESC guidelines isthe recommendation to establish a multidisciplinary‘endocarditis team’. Such a team, comprising—atleast—a cardiologist, cardio-thoracic surgeon, infec-tious diseases specialist, microbiologist and radiolo-gist/nuclear medicine physician should provide theexpertise needed to treat complex IE patients. Theguidelines refer—among other things—to the teamapproach adopted in France, with standardised med-ical therapy and uniform recommendations for surgi-cal interventions that were found to improve outcomerelative to earlier experience [14–18]. A comparablerecommendation has been made in the AHA/ACC

guidelines for the management of patients with valvu-lar disease [19]. In line with the ESC guidelines, theworking group recommended that each of the current16 Dutch tertiary referral centres with cardio-tho-racic facilities create a specific regional endocarditisteam. Moreover, the working group proposed to qual-ify the presence and composition of such a team asa quality indicator. The working group endorsed theESC guidelines recommendation that centres withoutcardio-thoracic facilities must consult the regionalendocarditis team in cases of (suspected) IE.

Antimicrobial therapy

There are major differences between European coun-tries in the use of antimicrobial therapy and con-sequently in the antibiotic resistance patterns ofpathogens. The Netherlands has the lowest rate ofantibiotic use in Europe. The result is a stable levelof antimicrobial resistance, whereas most countriesexperience increasing levels each year. Europeanguidelines for antimicrobial therapy therefore can-not be simply adhered to but have to be tailored toindividual countries. Recommendations for antibi-otic therapy in the Netherlands are provided by theStichting Werkgroep Antibiotica Beleid (SWAB; DutchWorking Party on Antibiotic Policy). Importantly,SWAB recently updated their guidelines for antibiotictreatment for IE, on the basis of an in-depth compari-son of the most recent ESC and the AHA IE guidelines.In cases of discordance between the recommenda-tions in these documents, SWAB guidance is basedon a formal literature review on best current Dutchpractice, taking into consideration national resistancepatterns and dosing habits. For all these reasons,the working group recommended the employmentof the SWAB guidelines for subsequent use in theNetherlands [20].

Main complications and their management

Heart failure resulting from valvular regurgitationor obstruction, uncontrolled infection and embolicevents occurring under adequate antibiotic treatmentconstitute major complications of IE and may requiresurgical treatment [1, 21–24]. The working group en-dorsed the ESC indications for cardiac surgery with-out modifications. However, the timing of the surgicalprocedure was left to the discretion of the specialistsinvolved. In accordance with the recommendationsof the ESC guidelines, complex IE patients should bereferred early to a regional centre with cardio-thoracicfacilities. Such cases include, but are not limited to,IE patients with congenital heart disease, PVE, preg-nant women, patients with heart failure, uncontrolledinfection, rhythm abnormalities or stroke.


Review Article

Fig. 3 Different examplesof major imaging diagnos-tic criteria: two cases ofpositive transoesophagealechocardiogram (a, b), onecase of positive 18F-FDGPET/CT (c, d) and one caseof positive cardiac CT (e,f). a A case of a mechan-ical aortic valve with signsof vegetation (red arrow).The red arrow in b alsoindicates a vegetation onthe aortic valve biopros-thesis, whereas the whitearrow indicates a possibleabscess of the aortic root.In c (fused PET/CT images)and in d (non-attenuatedPET images) the white ar-rows indicate 18F-FDG up-take around the aortic valvebioprosthesis as a sign ofpossible infection. The redarrow in e indicates a vege-tation on one of the leafletsof an aortic valve biopros-thesis. Finally, the red ar-row in f indicates a my-cotic aneurysm alongsidethe aortic valve bioprosthe-sis

Funding Thisworkwas supportedby theStichting Kwaliteits-gelden Medische Specialisten.

Conflict of interest A.R. Wahadat, J.W. Deckers, R.P.J. Budde,J.T.M. vanderMeer, E.H.Natour, J. ten Oever, A.L.J. Kortlever-vanderSpek, B.H.Stegeman,N.J.Verkaik, J.W.Roos-Hesselinkand W. Tanis declare that they have no competing interests.

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References

1. Habib G, Lancellotti P, AntunesMJ, et al. 2015 ESC Guide-linesfor themanagementof infectiveendocarditis: theTaskForce for the Management of Infective Endocarditis of theEuropean Society of Cardiology (ESC). Endorsed by: Eu-ropean Association for Cardio-Thoracic Surgery (EACTS),


http://creativecommons.org/licenses/by/4.0/

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theEuropeanAssociationofNuclearMedicine(EANM).EurHeartJ.2015;36(44):3075–128.

2. Habib G, Erba PA, Iung B, et al. Clinical presentation,aetiology and outcome of infective endocarditis. Resultsof the ESC-EORP EURO-ENDO (European infective endo-carditis) registry: a prospective cohort study. Eur Heart J.2019;40(39):3222–32.

3. Centre for Clinical Practice at NICE (UK).. Prophylaxisagainst infective endocarditis: antimicrobial prophylaxisagainst infective endocarditis in adults and children un-dergoing interventional procedures. 2008. https://www.nice.org.uk/guidance/cg64, updatedMar: Infective endo-carditis in adults and children undergoing interventionalprocedures. 2008. Accessed: 3June2020.

4. ThornhillMH,ChambersJB,DayerM,ShansonD.Achangein theNICE guidelines on antibiotic prophylaxis for dentalprocedures. BrJGenPract. 2016;66(650):460–1.

5. DuvalX,HoenB.Prophylaxis for infectiveendocarditis: let’sendthedebate. Lancet. 2015;385(9974):1164–5.

6. BodeLGM,Kluytmans JAJW,WertheimHFL, et al. Prevent-ing surgical-site infections innasal carriersof Staphylococ-cusaureus.NEngl JMed. 2010;362(1):9–17.

7. TanisW, Teske AJ, vanHerwerden LA, et al. The additionalvalue of three-dimensional transesophageal echocardiog-raphyincomplexaorticprostheticheartvalveendocarditis.Echocardiography. 2015;32(1):114–25.

8. Wahadat AR, TanisW, Swart LE, et al. Added value of (18)F-FDG-PET/CT and cardiac CTA in suspected transcatheteraortic valveendocarditis. JNuclCardiol. 2019; https://doi.org/10.1007/s12350-019-01963-x.

9. Mahmood M, Kendi AT, Ajmal S, et al. Meta-analysis of18F-FDGPET/CTinthediagnosisof infectiveendocarditis.JNuclCardiol. 2019;26(3):922–35.

10. Tanis W, Budde RPJ, van der Bilt IAC, et al. Novel imagingstrategiesforthedetectionofprostheticheartvalveobstruc-tionandendocarditis. NethHeartJ.2016;24(2):96–107.

11. Habib G, Hoen B, Tornos P, et al. Guidelines on theprevention, diagnosis, and treatment of infective endo-carditis (new version 2009): the Task Force on the Preven-tion, Diagnosis, and Treatment of Infective Endocarditisof the European Society of Cardiology (ESC). Endorsed bythe European Society of Clinical Microbiology and Infec-tious Diseases (ESCMID) and the International Society ofChemotherapy (ISC) for Infection andCancer. EurHeart J.2009;30(19):2369–413.

12. Hill EE, Herijgers P, Claus P, Vanderschueren S, Peeter-mansWE,HerregodsMC.Abscess in infectiveendocarditis:the value of transesophageal echocardiography and out-come: a5-yearstudy. AmHeartJ.2007;154(5):923–8.

13. Tanis W, Scholtens A, Habets J, et al. CT angiographyand 18F-FDG-PET fusion imaging for prostheticheart valveendocarditis. JACCCardiovascImaging. 2013;6(9):1008–13.

14. Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramaticreduction in infective endocarditis-related mortality witha management-based approach. Arch Intern Med.2009;169(14):1290–8.

15. Chirillo F, Scotton P, Rocco F, et al. Impact of a multidisci-plinary management strategy on the outcome of patientswith native valve infective endocarditis. Am J Cardiol.2013;112(8):1171–6.

16. Kaura A, Byrne J, Fife A, et al. Inception of the ‘en-docarditis team’ is associated with improved survival inpatientswithinfectiveendocarditiswhoaremanagedmed-ically: findings fromabefore-and-after study. OpenHeart.2017;4(2):e699.

17. El-Dalati S,Khurana I, SoperN, etal. Physicianperceptionsof amultidisciplinary endocarditis team. Eur J ClinMicro-biol InfectDis. 2019; https://doi.org/10.1007/s10096-019-03776-9.

18. Davierwala PM, Marin-Cuartas M, Misfeld M, Borger MA.The value of an “Endocarditis Team”. Ann CardiothoracSurg. 2019;8(6):621–9.

19. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACCfocused update of the 2014 AHA/ACC Guideline for theManagement of Patients with ValvularHeart Disease: a re-portoftheAmericanCollegeofCardiology/AmericanHeartAssociation Task Force on Clinical Practice Guidelines.Circulation. 2017;135(25):e1159–e95.

20. Stichting werkgroep antibiotica beleid. Nieuwe SWABrichtlijnengepubliceerd. 2019. https://swab.nl/nl/article/nieuws/490/nieuwe-swab-richtlijnen-gepubliceerd. Ac-cessed: 3June2020.

21. Nadji G, Rusinaru D, Rémadi JP, Jeu A, Sorel C, Tribouil-loyC.Heart failure in left-sidednative valve infective endo-carditis: characteristics, prognosis, and results of surgicaltreatment. EurJHeartFail. 2009;11(7):668–75.

22. ThunyF,BeurtheretS,Mancini J, etal. Thetimingof surgeryinfluences mortality and morbidity in adults with severecomplicated infective endocarditis: a propensity analysis.EurHeartJ.2011;32(16):2027–33.

23. Lalani T, Chu VH, Park LP, et al. In-hospital and1-year mortality in patients undergoing early surgeryfor prosthetic valve endocarditis. JAMA Intern Med.2013;173(16):1495–504.

24. Kang DH, Kim YJ, Kim SH, et al. Early surgery versusconventional treatment for infective endocarditis. NEngl JMed. 2012;366(26):2466–73.

25. Li JS, Sexton DJ, Mick N, et al. Proposed modifications totheDukecriteria for thediagnosisof infectiveendocarditis.ClinInfectDis. 2000;30(4):633–8.

26. NarducciML, PelargonioG,RussoE, et al. Usefulness of in-tracardiacechocardiographyfor thediagnosisofcardiovas-cular implantable electronic device-related endocarditis.JAmCollCardiol. 2013;61(13):1398–405.


https://www.nice.org.uk/guidance/cg64https://www.nice.org.uk/guidance/cg64https://doi.org/10.1007/s12350-019-01963-xhttps://doi.org/10.1007/s12350-019-01963-xhttps://doi.org/10.1007/s10096-019-03776-9https://doi.org/10.1007/s10096-019-03776-9https://swab.nl/nl/article/nieuws/490/nieuwe-swab-richtlijnen-gepubliceerdhttps://swab.nl/nl/article/nieuws/490/nieuwe-swab-richtlijnen-gepubliceerd

Implementation of the 2015 European Society of Cardiology guidelines for the management of infective endocarditis in the NetherlandsAbstractBackground and introductionPrevention and prophylaxisMicrobiological diagnosis

Diagnostic imaging and criteriaThe ‘endocarditis team’

Antimicrobial therapyMain complications and their managementReferences

implementationofthe2015europeansocietyofcardiology ... · 2020. 11. 23. · european society of...

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