2023-08-30 13:37:53
During the ESC 2023 annual meeting, European cardiologists presented an updated guideline for infective endocarditis. Document published on the society website.
Particular attention in the new guidelines is given to educating patients with valvular heart disease and congenital anomalies, as well as those in need of a pacemaker, on preventive measures. These include strict adherence to the rules of oral and skin hygiene, taking into account the risk subgroup.
In the highest-risk group, prophylactic antibiotics are recommended before dental or oral procedures. For patients at intermediate risk, the need for antibiotic prophylaxis before dental procedures should be considered on a case-by-case basis. People at low risk do not need antibiotic prophylaxis.
The document notes that the main target of antibiotic prophylaxis is streptococci in the oral cavity. Due to the growing resistance, care must be taken in the use of antibiotics and self-medication should be avoided.
Additional preventive measures for intermediate to high risk patients include twice-daily dental cleaning, professional dental cleaning (twice a year for high-risk patients and annually for moderate-risk patients), GP consultation for fever of unspecified etiology, strict skin hygiene, treatment of chronic skin diseases and disinfection of wounds. In these patient subgroups, avoidance of piercings and tattoos is highly recommended.
Imaging techniques such as computed tomography, nuclear magnetic resonance imaging, and magnetic resonance imaging have been added to the diagnostic criteria. New diagnostic algorithms can detect infections affecting intact heart valves, prosthetic heart valves, and implanted pacemakers and defibrillators.
The main method of therapy remains antibiotic therapy in accordance with the results of bacteriological blood culture. The duration of treatment depends on the severity of the infection. Surgery to remove infected material and drain abscesses is indicated in patients with heart failure or uncontrolled infection and to prevent embolism. The new recommendation is to perform surgery earlier than previously accepted.
Special attention is paid to stroke, one of the most severe complications of endocarditis. The new recommendations are to perform urgent heart valve surgery in patients with ischemic stroke due to embolism, but to delay surgery in patients with hemorrhagic stroke. In selected patients with stroke, catheter thrombectomy may be considered.
Also added to the guide is a section on patient-centered care and collaborative decision-making. The disease requires long-term treatment and can cause emotional stress for patients and family members, the paper notes. Patients should be given comprehensive attention to achieve the best physical and psychological results.
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