• Aortic Diseases

Guidelines for management of patients with infective endocarditis (IE) from the European Society of Cardiology,1 American College of Cardiology/American Heart Association2 3 and British Society for Antimicrobial Chemotherapy4 provide detailed recommendations for prevention of IE; diagnosis based on clinical, bacteriological and imaging findings; medical therapy including the type, route and duration of antibiotic administration; and the indications, type and timing of surgical intervention. These guideline documents have the goal to base each specific recommendation on the published evidence and follow a formal development process with inclusion of appropriate expertise, management of potential conflicts of interest, evidence summaries, consensus building, a standardised scale for class of recommendation and level of evidence, and internal and external review followed by publication and dissemination of the final document. These guideline documents serve as the foundation for management of patients with IE.

Yet, guidelines cannot address all facets of patient care. In particular, the implementation of guidelines in clinical practice depends on details unique to each healthcare system, patient population and socioeconomic considerations, among other factors. Despite advances in antimicrobial therapy and cardiac surgery over the past several decades, mortality in patients with IE remains very high at 20%–30% and we see increasing numbers of older adults with infected electronic cardiac devices or prosthetic valves. In addition, many clinicians with primary responsibility for management of a patient with IE have little experience with this diagnosis and are located at district …