2023 European Society of Cardiology guidelines for the management of infective endocarditis: Statement of endorsement by the NVVC Full version

TL;DR

This paper summarizes and evaluates the 2023 European Society of Cardiology guidelines for managing infective endocarditis, with specific insights for clinical practice in the Netherlands.

Contribution

The paper provides a refined antibiotic prophylactic regimen and revised surgical recommendations for infective endocarditis management.

Findings

A simplified antibiotic prophylactic regimen and updated guidance for blood culture-negative infective endocarditis were proposed.

The role of the Endocarditis Team was reaffirmed, along with reinforced imaging recommendations for infective endocarditis cases.

A preliminary recommendation for oral antibiotic therapy in viridans streptococci-caused endocarditis and revised surgical criteria were introduced.

Abstract

This review evaluates the 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) and offers insights into topics particularly relevant to clinical practice in the Netherlands. The multidisciplinary IE Working Group assessed all ESC recommendations and concluded that the majority could be endorsed, albeit with certain modifications. The IE Working Group presents a refined (and simplified) antibiotic prophylactic regimen and an updated table to guide the analysis of suspected blood culture-negative IE. Furthermore, the pivotal role of the Endocarditis Team in the management of patients with suspected and confirmed IE was reaffirmed, along with reinforced recommendations for nearly all cardiac and extracardiac imaging in these cases. Notably, a preliminary recommendation was issued for switching to oral antibiotic therapy in patients with native valve endocarditis caused by viridans streptococci, while awaiting the revision of the Dutch Working Group on Antibiotic Policy (SWAB) IE guideline. In addition, the surgical recommendations were evaluated and revised, including improved clinical criteria in case of cardiac surgery following neurological complications of IE and an advised disregard of the new class I ESC recommendation for surgery in early prosthetic valve endocarditis (< 6 months). Moreover, an additional device recommendation was proposed for the choice of (alternate) devices in case of device reimplantation after IE.

The online version of this article (10.1007/s12471-025-02010-w) contains supplementary material, which is available to authorized users.

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