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2015 ESC Guidelines on the management of infective endocarditis: a big step forward for an old disease
  1. Gilbert Habib1,2,
  2. Patrizio Lancellotti3,4,
  3. Bernard Iung5
  1. 1Aix-Marseille Université, Marseille, France
  2. 2Cardiology Department, APHM, La Timone Hospital, Marseille, France
  3. 3Department of Cardiology, University Hospital Sart Tilman, GIGA-Cardiovascular Sciences, Liège, Belgium
  4. 4Gruppo Villa Maria Care and Research, Anthea Hospital, Paris, France
  5. 5Cardiology Department, Bichat Hospital, AP-HP, DHU Fire and Paris Diderot University, Paris, France
  1. Correspondence to Dr Gilbert Habib, Aix-Marseille Université, Marseille 13005, France; gilbert.habib{at}

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In 2009, the European Society of Cardiology (ESC) Guidelines on the prevention, diagnosis and treatment of infective endocarditis (IE)1 introduced several innovative concepts, including limitation of antibiotic prophylaxis to the highest-risk patients, a focus on healthcare-associated IE and identification of the optimal timing for surgery. The recently published 2015 ESC Guidelines on the management of IE2 recently reinforced these changes and proposed new important features, including the need for a collaborative approach (the ‘Endocarditis Team’), the emergence of nuclear imaging techniques in the early diagnosis of IE and the refinement of surgical indications.

This editorial will focus in the main changes reported in the 2015 ESC Guidelines as compared with previous recommendations.

Prevention rather than prophylaxis: focus on healthcare IE

The new 2015 ESC Guidelines were ‘conservative’ on this topic, and can be summarised as follows:

  • The principle of antibiotic prophylaxis when performing procedures at risk of IE in patients with predisposing cardiac conditions is maintained.

  • Antibiotic prophylaxis must be limited to patients with the highest risk of IE (including prosthetic valves) undergoing the highest-risk dental procedures (dental procedures requiring manipulation of the gingival or periapical region of the teeth or perforation of the oral mucosa).

  • Good oral hygiene and regular dental review are more important than antibiotic prophylaxis to reduce the risk of IE.

  • Aseptic measures are mandatory during venous catheter manipulation and during any invasive procedures in order to reduce the rate of healthcare-associated IE.

Some recent epidemiological studies alerted the scientific community on the risk of increased incidence of IE following the reduction of antibiotic prophylaxis.3 ,4 However, since this trend was not observed in other studies, and because of the known worse prognosis of IE in high-risk patients, in particular those with prosthetic IE, 2015 ESC Guidelines maintained the principle of antibiotic prophylaxis in high-risk patients and focused for the …

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  • Competing interests BI has received consultant fees from Abbott, Boehringer Ingelheim and Valtech, and speaker's fees from Edwards Lifesciences. Gh and PL have no competing interests.

  • Provenance and peer review Commissioned; internally peer reviewed.