2015 ESC Guidelines for the management of infective endocarditis
Infective endocarditis (IE) is a deadly disease. Despite improvements in its management, IE remains associated with high mortality and severe complications. Until recently, guidelines on IE were mostly based on expert opinion because of the low incidence of the disease, the absence of randomized trials and the limited number of meta-analyses.
The 2009 ESC Guidelines on the prevention, diagnosis and treatment of IE8 introduced several innovative concepts, including limitation of antibiotic prophylaxis to the highest-risk patients, a focus on healthcare-associated IE and identification of the optimal timing for surgery. However, several reasons justify the decision of the ESC to update the previous guidelines: the publication of new large series of IE, including the first randomized study regarding surgical therapy; important improvements in imaging procedures, particularly in the field of nuclear imaging; and discrepancies between previous guidelines. In addition, the need for a collaborative approach involving primary care physicians, cardiologists, surgeons, microbiologists, infectious disease (ID) specialists and frequently other specialists— namely the ‘Endocarditis Team’—has been underlined recently and will be developed in these new guidelines.
The main objective of the current Task Forcewas to provide clear and simple recommendations, assisting healthcare providers in their clinical decision making. These recommendations were obtained by expert consensus after thorough review of the available literature. An evidence-based scoring system was used, based on a classification of the strength of recommendations and the levels of evidence.