Prevention, Diagnosis & Management of Infective Endocarditis 2017

Infective endocarditis (IE) is an uncommon and potentially lethal infection affecting patients at risk. Despite advances in medicine, IE still causes significant morbidity and mortality. This is due to the changing epidemiology of the disease, the wide spectrum of presentation extending from the neonate to the elderly, diagnostic difficulties, delayed surgical interventions and embolic complications. The advances in cardiothoracic surgery and cardiology over the years with the increasing use of prosthetic material, valves and intracardiac devices have also contributed to the challenges in managing IE in these patients.

Some important evolution in management strategies would be the development of an Endocarditis Team with multidisciplinary expertise in cardiology, cardiothoracic surgery, infectious disease and other subspecialties as indicated. This is encouraged to enable early diagnosis, optimise treatment and prevent complications in these patients. It also allows for smoother and more efficient referrals to specialised centres.

Previously, surgical intervention was delayed because of the high-risk and mortality but, recently published data have also shown that early surgical interventions in these patients decrease embolic complications and improve outcomes. There have also been changes with regards to antimicrobial prophylaxis. The evidence currently shows that routine antimicrobial prophylaxis prior to dental procedures is not indicated for all cardiac patients and should be limited to high-risk cardiac patients only. Maintaining a good oral and skin hygiene routine is highly recommended in the prevention of IE.

With these recent developments in the prevention, diagnosis and management of IE, it is timely that we develop local clinical practice guidelines to update all respective healthcare providers with regards to the new management strategies. I congratulate the committee for the effort and hope that these guidelines would serve to decrease the incidence of IE and its associated morbidity and mortality.

 

Datuk Dr. Noor Hisham Bin Abdullah
Director-General of Health Malaysia
Ministry of Health Malaysia

 

Statement of intent:

These clinical practice guidelines are meant to be a guide for clinical practice. It is based on the best available evidence, knowledge and clinical experience at the time of development. These guidelines do not guarantee the best outcome in every case and the responsibility lies on the individual healthcare provider to manage his/her patient based on the clinical manifestations of the patient and the management options available locally.

Period of validity:

These clinical practice guidelines were issued in 2017 and will be reviewed in 4 years (2021) or earlier depending on the availability of new evidence. NHAM will inform either the Chairperson of this current CPG committee or the National Advisor of the related specialties when the time for updating this CPG is due. Prior to commencement of updating this CPG, a discussion to determine the need for an update, including the scope of the CPG updates should be done. If there is a need for an update, as with this current committee, a multidisciplinary team will be formed for the specific purpose of updating this CPG.

 

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