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ESC/AHA-Endokarditisleitlinien 2015

Wettstreit oder Gleichklang?

ESC and AHA guidelines 2015 on endocarditis

In competition or synchrony?

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Zusammenfassung

Die 2015 von der ESC und der AHA veröffentlichten Leitlinien zur infektiösen Endokarditis stützen sich in der Diagnostik auf die modifizierten Duke-Kriterien. Diese beruhen auf dem Nachweis endokarditistypischer Erreger und dem Nachweis der endokarditischen Läsion in der Bildgebung, die sich neben der transthorakalen und transösophagealen Echokardiographie auch PET/CT, Kardio-CT und nuklearmedizinischer Methoden bedienen kann. Das Management soll durch ein interdisziplinäres Endokarditisteam im dafür ausgewiesenen Referenzzentrum weiter verbessert werden. Die medikamentöse Behandlung stützt sich weitgehend unverändert auf bewährte Antibiotika in Mono- oder Kombinationstherapie. Lediglich bei Staphylokokkenendokarditis kann auf Gentamycin verzichtet werden. Bis zu 50 % der Fälle müssen früher oder später einer herzchirurgischen Maßnahme zugeführt werden. Die Dringlichkeit dieses Eingriffs hängt ab vom Ausmaß der Herzinsuffizienz, der Erregerpersistenz trotz Antibiose und den neurologischen Komplikationen.

Abstract

In the 2015 guidelines of the European Society of Cardiology (ESC) and the American Heart Association (AHA) on infective endocarditis, the diagnostics are based on the modified Duke criteria. The diagnosis can be confirmed by a combination of micro-organisms demonstrated in culture or in situ, with the detection of valvular lesions or abscess formation by an imaging modality using echocardiography, positron emission tomography computed tomography (PET/CT), cardio-CT or nuclear medical methods. The management should be further improved by an interdisciplinary endocarditis team in a specifically designated reference center. Pharmaceutical treatment is largely unchanged and based on classical antibiotics in monotherapy or as combination therapy but for staphylococcal endocarditis, gentamycin is no longer required. As cardiac surgery is needed in 50 % of the cases during the course of the disease, the urgency for surgery depends on the extent of cardiac insufficiency, the persistence of the pathogen despite antibiotic treatment and on neurological complications.

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Authors and Affiliations

  1. Feldbergstr. 45, 35043, Marburg, Deutschland

    Bernhard Maisch EFESC, FACC

  2. Philipps Universität Marburg und Herz- und Herz- und Gefäßzentrum Marburg, Marburg, Deutschland

    Bernhard Maisch EFESC, FACC

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  1. Bernhard Maisch EFESC, FACC
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Correspondence to Bernhard Maisch EFESC, FACC.

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Interessenkonflikt

B. Maisch gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Maisch, B. ESC/AHA-Endokarditisleitlinien 2015. Herz 41, 690–696 (2016). https://doi.org/10.1007/s00059-016-4494-5

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