Guidelines for Diagnosis and Management of Infective Endocarditis in Adults

Abstract

ImportancePractice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence.ObjectiveTo create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength.Evidence ReviewThis consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches.FindingsA total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)–only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions.Conclusions and RelevanceIn this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed.

Ten common misconceptions about antibiotic use in the hospital

“…15 Contemporary literature reviewing the administration of oral versus parenteral therapy for select cases of osteomyelitis, infective endocarditis, and bacteremia has confirmed the usage of oral therapies to be effective if optimal doses can be clinically achieved. [16][17][18] Additionally, the usage of oral therapies obviates the risk of phlebitis, thrombosis, and line-associated bloodstream T A B L E 1 Antimicrobials with high oral bioavailability. 14…”

Error in Box 1

“…In the description of vancomycin as a principal agent for native valve infective endorcarditis, Staphylococcus aureus originally appeared as Streptococcus aureus. This article has been corrected …”

“…In the Consensus Statement titled “Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement,” 1 published July 31, 2023, there was an error in Box 1. In the description of vancomycin as a principal agent for native valve infective endorcarditis, Staphylococcus aureus originally appeared as Streptococcus aureus.…”

Errors in Table and Supplement 1

“…In the Consensus Statement titled “Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement,” published July 31, 2023, there were errors in Table 2 and eTable 3 in Supplement 1. In Table 2 and eTable 3 in Supplement 1, the units for penicillin should have been micrograms per milliliter.…”

“…In Table 2 and eTable 3 in Supplement 1, the units for penicillin should have been micrograms per milliliter. This article has been corrected …”