International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines.
OBJECTIVE
The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy.


METHODS
Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015.


RESULTS
The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data.


CONCLUSIONS
Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics.
URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France.
H
H
Tissot-Dupont
URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France.
J P
JP
Casalta
URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France.
F
F
Gouriet
Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France.
S
S
Hubert
Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France.
E
E
Salaun
Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France.
G
G
Habib
Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France.
M P
MP
Fernandez-Gerlinger
Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France.
J L
JL
Mainardi
Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France.
P
P
Tattevin
Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France.
M
M
Revest
Infectious Diseases Department, University Hospital of Saint-Etienne, France.
F
F
Lucht
Infectious Diseases Department, University Hospital of Saint-Etienne, France.
E
E
Botelho-Nevers
Infectious Diseases Department, University Hospital of Saint-Etienne, France.
A
A
Gagneux-Brunon
Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
U
U
Snygg-Martin
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
K L
KL
Chan
Infectious Disease Unit Rabin Medical Centre, Beilinson Hospital Sackler Faculty of Medicine, Tel-Aviv University, Jabotinsky 39, Petah-Tiqva, Israel.
J
J
Bishara
Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain.
I
I
Vilacosta
Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain.
C
C
Olmos
Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
J A
JA
San Román
Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
J
J
López
Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
P
P
Tornos
Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
N
N
Fernández-Hidalgo
Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy.
E
E
Durante-Mangoni
Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy.
R
R
Utili
Ramban Health Care Campus, Haifa, Israel.
M
M
Paul
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
L M
LM
Baddour
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
D C
DC
DeSimone
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
M R
MR
Sohail
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
J M
JM
Steckelberg
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
W R
WR
Wilson
URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France. Electronic address: didier.raoult@gmail.com.
D
D
Raoult
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004696:Endocarditis / Q000188:drug therapy* / Q000401:mortality; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D016019:Survival Analysis
D000900:Anti-Bacterial Agents
Blood culture negative endocarditis; Endocarditis Treatment; Experts; Guidelines and practice; Staphylococcus aureus endocarditis