Abstract
Because the occurrence of infective endocarditis (IE) continues to be associated with high mortality, a working group was created by the Dutch Society of Cardiology to examine how the most recent European Society of Cardiology (ESC) guidelines for IE management could be implemented most effectively in the Netherlands. In order to investigate current Dutch IE practices, the working group conducted a country-wide survey. Based on the results obtained, it was concluded that most ESC recommendations could be endorsed, albeit with some adjustments. For instance, the suggested pre-operative screening and treatment of nasal carriers of Staphylococcus aureus as formulated in the ESC guideline was found to be dissimilar to current Dutch practice, and was therefore made less restrictive. The recently adapted ESC diagnostic criteria for IE were endorsed, while the practical employment of the relevant diagnostic techniques was simplified in an adapted flowchart. In addition, the presence of a multidisciplinary, so-called ‘endocarditis team’ in tertiary centres was proposed as a quality indicator. An adapted flowchart specifically tailored to Dutch practice for microbiological diagnostic purposes was constructed. Lastly, the working group recommended the Stichting Werkgroep Antibioticabeleid (SWAB; Dutch Working Party on Antibiotic Policy) guidelines for IE treatment instead of the antibiotic regimens proposed by the ESC.
Highlights
Background and introductionOne of the oldest cardiac diseases, infective endocarditis (IE), remains one of the most fatal manifestations of heart disease [1]
Computed tomography (CT), positron emission tomography with computed tomography (CT) (PET-CT) and magnetic resonance imaging have emerged as valuable additional imaging techniques that provide complementary diagnostic information to echocar
Available data— from the Netherlands—indicate increased diagnostic accuracy when these techniques are added to the modified Duke criteria, especially in prosthetic valve endocarditis (PVE) [8,9,10]
Summary
One of the oldest cardiac diseases, infective endocarditis (IE), remains one of the most fatal manifestations of heart disease [1]. Despite considerable progress in diagnosis and treatment, the in-hospital mortality of IE continues to be about 20%, essentially unchanged during the past decades [2]. Budde Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands. Tanis Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands. M. van der Meer Department of Internal Medicine and Infectious Diseases, AmsterdamUMC, location AMC, Amsterdam, The Netherlands. Natour Department of Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. J. ten Oever Department of Internal Medicine and Radboud Centre for Infectious diseases, Radboud University Medical Centre, Nijmegen, The Netherlands. H. Stegeman Knowledge Institute of the Federation of Medical Specialists, Utrecht, The Netherlands. Verkaik Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
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