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[Practice guidelines of the Spanish Society of Cardiology on endocarditis]
F Vallés1, M Anguita, M P Escribano
1Sociedad Española de Cardiología.
Insights
Infectious endocarditis, a serious heart valve infection, requires prompt diagnosis using clinical, bacteriological, and echocardiographic methods. This review presents updated recommendations for prophylaxis, diagnosis, and treatment, including antibiotic selection and surgical indications.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Context:
- Infectious endocarditis (IE) is a severe cardiac valve infection with high morbidity and mortality.
- Etiology involves diverse microorganisms, necessitating tailored treatment strategies.
- Optimal prophylaxis and treatment guidelines remain areas of active research and clinical importance.
Purpose:
- To present current recommendations for the prophylaxis, diagnosis, and management of infectious endocarditis.
- To clarify diagnostic criteria, emphasizing the role of echocardiography (transthoracic and transesophageal).
- To guide antibiotic therapy selection based on microbial susceptibility and provide empirical guidelines for culture-negative cases.
Summary:
- Diagnosis relies on integrated clinical, bacteriological, and echocardiographic data, primarily Duke's criteria.
- Echocardiography is crucial for both diagnosis and guiding therapeutic decisions.
- Antibiotic therapy must be guided by isolated pathogens and their in vitro susceptibility, with specific recommendations for empirical treatment.
Impact:
- Provides clinicians with updated evidence-based guidelines for managing infectious endocarditis.
- Aims to improve patient outcomes by optimizing diagnostic accuracy and therapeutic interventions.
- Highlights the importance of tailored prophylaxis and timely surgical consideration in complex cases.
Abstract:
Infectious endocarditis is a disease which mainly involves the cardiac valves. It has a bad prognosis and is caused by a great variety of microorganisms. Prophylaxis is important although the effectiveness and the best way to achieve it remain unclear. Recommendations are herein presented. The diagnosis is based on clinical, bacteriological, and echocardiographic findings mainly based on Duke's criteria. Transthoracic and transesophageal echography are not only of diagnostic value but are also a tool to determine the therapy to follow. Antibiotic therapy should be selected according to the organisms isolated and their in vitro susceptibility. Guidelines for empirical antibiotic therapy in cases of negative cultures are also included. Lastly, indications and time for surgery are discussed.