The American Heart Association has issued a multidisciplinary scientific statement on the diagnosis, antibiotic therapy and management of infective endocarditis, replacing its 2015 document. The authors set out what has changed in the interval: rising incidence, a shifted epidemiology, updated case definitions, non-culture-based pathogen identification, and advanced multimodality imaging.
Two management shifts are named directly. A randomised trial of partial oral antibiotic therapy published in 2019 is described as likely to change the treatment landscape, and percutaneous mechanical aspiration of right-sided vegetations is now used in selected patients whose infection is not controlled on appropriate antimicrobials. The statement also presses the case for a formal endocarditis team rather than ad hoc referral between cardiology, infection and surgery.
In practice this is a prompt to look at your own pathway. Most units wrote their endocarditis protocol against the 2015 document, which means the diagnostic criteria in use, the imaging sequence and the default of six weeks of intravenous therapy all predate the evidence the statement now incorporates. Whether an endocarditis team exists on paper is a different question from whether one meets.
- Check which case definition your microbiology and cardiology teams are applying, and whether it is the updated one
- Establish who convenes the endocarditis team, how quickly, and who attends from cardiac surgery
- Identify which patients on your ward could be candidates for oral step-down rather than a full intravenous course
- Confirm what multimodality imaging you can actually access out of hours, not what is theoretically available
- Record the pathogen identification method used when cultures are negative
Why it matters
Most endocarditis protocols in use were written against guidance that predates oral step-down therapy and non-culture pathogen identification.
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