Organization and Functioning of a Multidisciplinary Team for the Diagnosis and Treatment of Infective Endocarditis: A 30-year Perspective (1985-2014)

Abstract

Infective endocarditis (IE) is a rare disease that is difficult to diagnose, its treatment is complex and expensive, and mortality is high (around 20%). In the field of IE, the most recent changes are epidemiological and include an increased number of cases of IE in patients with prosthetic valves and intracardiac devices and in the population receiving health care, an increased number of cases of Staphylococcus aureus IE, and changes in antibiotic sensitivity patterns with a particular impact on vancomycin. Infective endocarditis requires prolonged hospitalization and resourceintensive treatment because antibiotic therapy, intensive care, and surgical treatment form part of the therapeutic approach. Between 40% and 50% of patients require surgical treatment in the acute phase. In the year when IE is diagnosed, mortality is 30% with or without intervention. Mortality is high among certain groups, such as patients with prosthetic valves and especially those with intracranial hemorrhage. Early diagnosis and treatment can improve outcomes. Low suspicion of IE can delay effective treatment and increase mortality. In our experience, an appropriate therapeutic approach has a mean delay of 27 days when the patient is referred from another institution. The treatment of IE is a paradigm of collaboration. Multidisciplinary teams (MDT) dedicated to IE have pioneered the organization of tertiary hospital care devoted to the disease. In the last decade, the International Collaboration in Endocarditis group has had a strong impact on understanding IE. The British Heart Valve Society has recommended the collaboration of specialists in valvular heart disease and IE and recent reports have supported this model.