An audit of the diagnosis and treatment of infective endocarditis

Abstract

Background Infective endocarditis (IE) is associated with a high incidence of mortality and morbidity and guidelines exist on appropriate diagnosis and treatment. The aim of the study was to evaluate adherence with national guidance and identify relevant learning experiences if indicated. Methods We performed a retrospective review of admissions to a district general hospital with a diagnosis of IE over a 1-year period from January 2018 to December 2018. Individual cases were identified during inpatient admission and notes reviewed to establish adherence to a published national audit tool. Information regarding initial investigation, and management was gathered from the medical notes and microbiology reporting of samples was also examined. Results Of the 16 cases identified: 93% did not have blood cultures taken appropriately before treatment was started and only 50% received the recommended empirical antibiotics. Only 43% had a transthoracic echocardiogram performed in the first 24 hours. A surgical opinion was sought in just 2 of 4 cases of prosthetic valve endocarditis. The three culture negative IE cases had no further recommended testing performed. Conclusion We highlighted a need for improved investigation and treatment of IE. Timeliness of transthoracic echocardiograms will be improved by a change to the request form to indicate if IE is suspected so scans can be prioritised. Clinicians will be informed if blood cultures are negative so further testing can be arranged if there is still a high clinical suspicion. A weekly microbiology ward round has been established to review all suspected cases of IE.