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European Heart Journal 2004 25(3):267-276; doi:10.1016/j.ehj.2003.11.008
Copyright © 2004 by the European Society of Cardiology.
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ESC Guidelines

Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis Executive Summary

The Task Force on Infective Endocarditis of the European Society of Cardiology

Task Force Members, Dieter Horstkotte, Chairperson, (Germany)*, Ferenc Follath, (Switzerland), Erno Gutschik, (Denmark), Maria Lengyel, (Hungary), Ali Oto, (Turkey), Alain Pavie, (France), Jordi Soler-Soler, (Spain), Gaetano Thiene, (Italy) and Alexander von Graevenitz, (Switzerland)

ESC Committee for Practice Guidelines (CPG), Silvia G. Priori, (Chairperson) (Italy), Maria Angeles Alonso Garcia, (Spain), Jean-Jacques Blanc, (France), Andrzej Budaj, (Poland), Martin Cowie, (UK), Veronica Dean, (Greeve), Jaap Deckers, (The Netherlands), Enrique Fernández Burgos, (Spain), John Lekakis, (Greece), Bertil Lindahl, (Sweden), Gianfranco Mazzotta, (Italy), João Morais, (Portugal), Ali Oto, (Turkey) and Otto A. Smiseth, (Norway)

Document Reviewers, John Lekakis, CPG Review Coordinator (Greece), Alec Vahanian, (France), François Delahaye, (France), Alexander Parkhomenko, (Ukraine), Gerasimos Filipatos, (Greece), Jan Aldershvile, (Denmark) and Panos Vardas, (Greece)

* Corresponding author: Chairperson: Dieter Horstkotte, MD, FESC, Professor and Head Department of Cardiology, Heart Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany. Tel.: +49-5731-971258; Fax: +49-5731-972194
E-mail address: akohlstaedt@hdz-nrw.de

The first 150 words of the full text of this article appear below.

Table of contents

Preamble
Introduction
Definitions, terminology
Prevention of infective endocarditis
    Cardiac condit
    Patient-related non-cardiac conditions
    Predisposing diagnostic and therapeuticinterventions
Prophylactic antibiotic regimens
Diagnosis
    History, symptoms, signs and laboratory tests
    Echocardiography
    Standard blood culture techniques
    Culture-negative endocarditis (CNE)
Treatment and management
    Antimicrobial therapy
    Drug level monitoring
    Empirical therapy
    Special subsets
Management of complications
Surgery for active NVE
Surgery for active PVE
    Postoperative antibiotic treatment
List of Abbreviations
Further Reading

1. Preamble

Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making.

A great number of Guidelines and Expert Consensus Documents have been issued in recent years by different organizations, the European Society of Cardiology (ESC) and by other related societies. By means of links to web sites of National Societies several hundred guidelines . . . [Full Text of this Article]

2. Introduction

3. Definitions, terminology

4. Prevention of infective endocarditis

4.1. Cardiac conditions/patients at risk
4.2. Patient-related non-cardiac conditions
4.3. Predisposing diagnostic and therapeutic interventions
5. Prophylactic antibiotic regimens

6. Diagnosis

6.1. History, symptoms, signs and laboratory tests
6.2. Echocardiography
6.3. Standard blood culture techniques
6.4. Culture-negative endocarditis (CNE)
7. Treatment and management

7.1. Antimicrobial therapy
7.2. Drug level monitoring
7.3. Empirical therapy
7.4. Special subsets
8. Management of Complications

9. Surgery for active NVE

10. Surgery for active PVE

10.1. Postoperative antibiotic treatment
11. List of Abbreviations


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Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346.
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Antimicrob. Agents Chemother.Home page
P. Diz Dios, I. Tomas Carmona, J. Limeres Posse, J. Medina Henriquez, J. Fernandez Feijoo, and M. Alvarez Fernandez
Comparative Efficacies of Amoxicillin, Clindamycin, and Moxifloxacin in Prevention of Bacteremia following Dental Extractions.
Antimicrob. Agents Chemother., September 1, 2006; 50(9): 2996 - 3002.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace, September 1, 2006; 8(9): 746 - 837.
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Eur Heart J SupplHome page
M. S. Nieminen
Key issues of European Society of Cardiology guidelines on acute heart failure
Eur. Heart J. Suppl., September 1, 2006; 8(suppl_E): E6 - E11.
[Abstract] [Full Text] [PDF]


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BMJHome page
R. P Beynon, V K Bahl, and B. D Prendergast
Infective endocarditis
BMJ, August 12, 2006; 333(7563): 334 - 339.
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J Med MicrobiolHome page
J. J. Clayton, W. Baig, G. W. Reynolds, and J. A. T. Sandoe
Endocarditis caused by Propionibacterium species: a report of three cases and a review of clinical features and diagnostic difficulties.
J. Med. Microbiol., August 1, 2006; 55(Pt 8): 981 - 987.
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StrokeHome page
E. Ruttmann, J. Willeit, H. Ulmer, O. Chevtchik, D. Hofer, W. Poewe, G. Laufer, and L. C. Muller
Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis
Stroke, August 1, 2006; 37(8): 2094 - 2099.
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HeartHome page
B D Prendergast
The changing face of infective endocarditis
Heart, July 1, 2006; 92(7): 879 - 885.
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J Antimicrob ChemotherHome page
F. K. Gould, T. S. J. Elliott, J. Foweraker, M. Fulford, J. D. Perry, G. J. Roberts, J. A. T. Sandoe, and R. W. Watkin
Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy
J. Antimicrob. Chemother., June 1, 2006; 57(6): 1035 - 1042.
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HeartHome page
J B Chambers, J L Klein, S R Bennett, M J Monaghan, and J C Roxburgh
Is antibiotic prophylaxis ever necessary before transoesophageal echocardiography?
Heart, April 1, 2006; 92(4): 435 - 436.
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Arch Intern MedHome page
S. M. Singh, C. D. Joyner, and D. A. Alter
The importance of echocardiography in physicians' support of endocarditis prophylaxis.
Arch Intern Med, March 13, 2006; 166(5): 549 - 553.
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QJMHome page
A.J. Todd, S.J. Leslie, M. MacDougall, and M.A. Denvir
Clinical features remain important for the diagnosis of infective endocarditis in the modern era
QJM, January 1, 2006; 99(1): 23 - 31.
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HeartHome page
G. Habib
Management of infective endocarditis
Heart, January 1, 2006; 92(1): 124 - 130.
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JAMAHome page
T. Chikamori
Endocarditis From Staphylococcus aureus
JAMA, December 21, 2005; 294(23): 2972 - 2972.
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Eur Heart JHome page
E. G. Butchart, C. Gohlke-Barwolf, M. J. Antunes, P. Tornos, R. De Caterina, B. Cormier, B. Prendergast, B. Iung, H. Bjornstad, C. Leport, et al.
Recommendations for the management of patients after heart valve surgery
Eur. Heart J., November 2, 2005; 26(22): 2463 - 2471.
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J. Thorac. Cardiovasc. Surg.Home page
E. Ruttmann, C. Legit, G. Poelzl, S. Mueller, O. Chevtchik, M. Cottogni, H. Ulmer, O. Pachinger, G. Laufer, and L. C. Mueller
Mitral valve repair provides improved outcome over replacement in active infective endocarditis
J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 765 - 771.
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J Antimicrob ChemotherHome page
J. D. Perry and on behalf of the Working Party of the British Soci
Endocarditis guidelines: authors' response
J. Antimicrob. Chemother., August 1, 2005; 56(2): 432 - 433.
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CirculationHome page
F. Thuny, G. Disalvo, O. Belliard, J.-F. Avierinos, V. Pergola, V. Rosenberg, J.-P. Casalta, J. Gouvernet, G. Derumeaux, D. Iarussi, et al.
Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography: A Prospective Multicenter Study
Circulation, July 5, 2005; 112(1): 69 - 75.
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Eur Heart JHome page
A. Pelliccia, R. Fagard, H. H. Bjornstad, A. Anastassakis, E. Arbustini, D. Assanelli, A. Biffi, M. Borjesson, F. Carre, D. Corrado, et al.
Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology
Eur. Heart J., July 2, 2005; 26(14): 1422 - 1445.
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HeartHome page
G Habib, C Tribouilloy, F Thuny, R Giorgi, A Brahim, M Amazouz, J-P Remadi, G Nadji, J-P Casalta, F Coviaux, et al.
Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases
Heart, July 1, 2005; 91(7): 954 - 959.
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HeartHome page
K Niwa, M Nakazawa, S Tateno, M Yoshinaga, and M Terai
Infective endocarditis in congenital heart disease: Japanese national collaboration study
Heart, June 1, 2005; 91(6): 795 - 800.
[Abstract] [Full Text] [PDF]


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Journal of Diagnostic Medical SonographyHome page
P. J. Peters
Infective Endocarditis
Journal of Diagnostic Medical Sonography, May 1, 2005; 21(3): 192 - 204.
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HeartHome page
P Tornos, B Iung, G Permanyer-Miralda, G Baron, F Delahaye, C. Gohlke-Barwolf, E G Butchart, P Ravaud, and A Vahanian
Infective endocarditis in Europe: lessons from the Euro heart survey
Heart, May 1, 2005; 91(5): 571 - 575.
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Eur. J. Cardiothorac. Surg.Home page
W. A. Goetz, A. Liebold, and D. E. Birnbaum
Reply to Chatzis et al.
Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 729 - 729.
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