Analysis of the 2015 American and European guidelines for the management of infective endocarditis.
The optimal management of infective endocarditis requires a broad range of expertise (infectious disease specialists, cardiologists, microbiologists, cardiac surgeons, and intensivists). Given the low level of evidence currently available to support the management of infective endocarditis, international guidelines have always been particularly awaited and rather well implemented. Their cautious analysis of the medical literature and the range of expertise combined within the groups in charge of these guidelines are usually broadly acknowledged and respected. The publications, a few weeks apart, of the 2015 updates of the American and European guidelines, was quite disturbing. Indeed, several discrepancies on major therapeutic propositions were observed, including empirical treatment (penicillin M+penicillin A+gentamicin for Europeans in acutely ill patients; penicillin A+beta-lactamase inhibitor+gentamicin for Americans), or first-line treatment for the most common pathogen responsible for endocarditis in 2016, Staphylococcus aureus (trimethoprim-sulfamethoxazole+clindamycin as an alternative in the European guidelines, while this regimen is not even mentioned in the American guidelines). Other discrepancies were observed, although less significant: the role of positron emission tomography labelled with18F-fluorodeoxyglucose and administration modalities for aminoglycosides. We aimed to detail the main changes brought upon by these guidelines, their discrepancies, and the 'pros' and 'cons' that may help you select the best treatment regimen for your patients.
Maladies infectieuses et réanimation médicale, CHU Pontchaillou, 35033 Rennes cedex, France. Electronic address: pierre.tattevin@chu-rennes.fr.
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Tattevin
Unité mobile de microbiologie clinique, service de microbiologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France.
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Mainardi
D000617:Aminoglycosides / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005062:European Union; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic / Q000592:standards; D016459:Prosthesis-Related Infections / Q000628:therapy; D019275:Radiopharmaceuticals; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D014481:United States
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C000615276:Fluorine-18
Endocardite infectieuse; Guidelines; Infective endocarditis; Positron emission tomography; Recommandations; Staphylococcus aureus; Streptococcus sp.; Tomographie par émission de positons