Abstract
Purpose of Review
The question of antibiotic prophylaxis and its role in prevention of infective endocarditis (IE) remains controversial, with differing recommendations from international societies. The aim of this review was to compare and contrast current recommendations on antibiotic prophylaxis for IE by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) and highlight the evidence supporting these recommendations.
Recent Findings
International guidelines for administration of antibiotic prophylaxis for prevention of IE are largely unchanged since 2009. Studies on the impact of the more restrictive antibiotic prophylaxis recommendations are conflicting, with several studies suggesting lack of adherence to current guidance from the ESC (2015), NICE (2016), and AHA (2021).
Summary
The question of antibiotic prophylaxis in patients with IE remains controversial, with differing recommendations from international societies. Despite the change in guidelines more than 15 years ago, lack of adherence to current guidelines persists. Due to the lack of high-quality evidence and the conflicting results from observational studies along with the lack of randomized clinical trials, the question of whether to recommend antibiotic prophylaxis or not in certain patient populations remains unanswered and remains largely based on expert consensus opinion.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Habib G. Infective endocarditis: epidemiology, diagnosis, imaging, therapy, and prevention. Infective Endocarditis: Epidemiology, Diagnosis, Imaging, Therapy, and Prevention. 2016;1–330.
Østergaard L, Oestergaard LB, Lauridsen TK, Dahl A, Chaudry M, Gislason G, et al. Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment: a nationwide population-based study. Eur J Cardio-Thoracic Surg Off J Eur Assoc Cardio-Thoracic Surg. 2018;54(5):860–6.
Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, et al. Validated risk score for predicting 6-month mortality in infective endocarditis. J Am Heart Assoc. 2016;5(4):1–13.
Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: A prospective cohort study. Eur Heart J. 2019;40(39):3222–3232B.
Østergaard L, Voldstedlund M, Bruun NE, Bundgaard H, Iversen K, Køber N, et al. Temporal changes, patient characteristics, and mortality, according to microbiological cause of infective endocarditis: a nationwide study. J Am Heart Assoc. 2022;11(16).
Østergaard L, Valeur N, Ihlemann N, Smerup MH, Bundgaard H, Gislason G, et al. Incidence and factors associated with infective endocarditis in patients undergoing left-sided heart valve replacement. Eur Heart J. 2018;39(28):2668–75.
Thuny F, Giorgi R, Habachi R, Ansaldi S, Le Dolley Y, Casalta JP, et al. Excess mortality and morbidity in patients surviving infective endocarditis. Am Heart J. 2012;164(1):94–101.
Khaloo P, Uzomah UA, Shaqdan A, Ledesma PA, Galvin J, Ptaszek LM, et al. Outcomes of patients hospitalized with cardiovascular implantable electronic device–related infective endocarditis, prosthetic valve endocarditis, and native valve endocarditis: a nationwide study, 2003 to 2017. J Am Heart Assoc. 2022;1–14.
Pries-Heje MM, Wiingaard C, Ihlemann N, Gill SU, Bruun NE, Elming H, et al. Five-year outcomes of the partial oral treatment of endocarditis (POET) trial. N Engl J Med. 2022;386(6):601–2.
Murdoch DR, Corey RG, Hoen B, Miró M, Fowler VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century The international collaboration on Endocarditis-prospective cohort study. Arch Intern Med. 2009;169(5):463–73.
Hammond-haley M, Hartley A, Al-khayatt BM, Delago AJ, Ghajar A, Ojha U, et al. Trends in the incidence and mortality of infective endocarditis in high-income countries between 1990 and 2019. Int J Cardiol. 2022.
Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods M, Peetermans WE. Infective endocarditis : changing epidemiology and predictors of 6-month mortality : a prospective cohort study. 2007;196–203.
Erichsen P, Gislason GH, Bruun NE. The increasing incidence of infective endocarditis in Denmark, 1994–2011. Eur J Intern Med. 2016;35(2016):95–9.
Olmos C, Vilacosta I, Fernández-Pérez C, Bernal JL, Ferrera C, García-Arribas D, et al. The evolving nature of infective endocarditis in Spain: a population-based study (2003 to 2014). J Am Coll Cardiol. 2017;70(22):2795–804.
Ternhag A, Cederström A, Törner A, Westling K. A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden. PLoS ONE. 2013;8(7):1–7.
Wildenthal JA, Atkinson A, Lewis S, Sayood S, Nolan NS, Cabrera NL, et al. Outcomes of partial oral antibiotic treatment for complicated S. aureus bacteremia in people who inject drugs. Clin Infect Dis. 2022;1093:1–10.
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 2007;116(15):1736–54.
Armiñanzas C, Fariñas-Alvarez C, Zarauza J, Muñoz P, González Ramallo V, Martínez Sellés M, et al. Role of age and comorbidities in mortality of patients with infective endocarditis. Eur J Intern Med. 2019;64(64):63–71.
Fowler VG, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, et al. Staphylococcus aureus endocarditis. JAMA. 2005;293(24):3012.
•• Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: updating the modified Duke criteria. Clin Infect Dis. 2023. This consensus paper presents an updated framework for the diagnostic criteria for IE, with inclusion of new imaging modalities, and the most recent data on bacterial pathogens causing IE.
Fisher RA, Gollan B, Helaine S. Persistent bacterial infections and persister cells. Nat Rev Microbiol. 2017;15(8):453–64.
•• Wilson WR, Gewitz M, Lockhart PB, Bolger AF, Desimone DC, Kazi DS, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021;143(20):E963–78. This statement from the AHA reviewed the published literature on antibiotic prophylaxis up until 2020 and found no evidence in favor of changing guidelines.
Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, et al. Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-Analysis. Heart. 2017;103(12):937–44.
National Institute for Health and Care Excellence (NICE). Prophylaxis against infective endocarditis antimicrobial prophylaxis against infective endocarditis in adults and children. Natl Inst Clin Excell CG64. 2008;1–107. Published 17 March 2008. Last updated 8 July 2016. Available from: https://www.nice.org.uk/guidance/cg64.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. ESC guidelines for the management of infective endocarditis. Vol. 36. Eur Heart J. 2015;2015:3075–123.
Bolger A, Kazi DS. Antibiotic prophylaxis against endocarditis prior to invasive dental procedures: filling in the gaps. J Am Coll Cardiol. 2022;80(11):1042–4.
Prevention of rheumatic fever and bacterial endocarditis through control of Streptococcal infections. Circulation. 1960;21(1):151–5.
Prevention of bacterial endocarditis. Med Lett Drugs Ther. 1987;29(754):109–10.
Dajani AS. Prevention of bacterial endocarditis. JAMA. 1997;277(22):1794.
Lockhart PB, Durack DT. Oral microflora as a cause of endocarditis and other distant site infections. Infect Dis Clin North Am. 1999;13(4):833–50.
Pallash T. Antibiotic prophylaxis and the medically compromised patient. Periodontol. 2000;10:107–38.
Pallasch TJ. Antibiotic prophylaxis: problems in paradise. Dent Clin North Am. 2003;47(4):665–79.
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2009;30(19):2369–413.
Stokes T, Richey R, Wrayon D. Prophylaxis against infective endocarditis: Summary of NICE guidance. Heart. 2008;94(7):930–1.
• Quan TP, Muller-Pebody B, Fawcett N, Young BC, Minaji M, Sandoe J, et al. Investigation of the impact of the NICE guidelines regarding antibiotic prophylaxis during invasive dental procedures on the incidence of infective endocarditis in England: an electronic health records study. BMC Med. 2020;18(1):1–17. This study examined the impact of the NICE guidelines on prevalence of IE in England. The authors found that although there was an increasing incidence of IE, this did not seem related to the timing of the NICE guidelines change, nor to oral streptococci in particular.
Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH, et al. An oncrease in the incidence of infective endocarditis in England since 2008: a secular trend interrupted time series analysis HHS Public Access. Lancet March. 2015;281016(385997414):1219–28.
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5).
National Institute for Health and Care Excellence (NICE). Surgical site infections: prevention and treatment NG125. Clin Guidel Natl Insitute Heal care Excell. 2020;1–29. Published: 11 April 2019. Last updated: 19 August 2020. Available from: www.nice.org.uk/guidance/ng125.
Suda KJ, Fitzpatrick MA, Gibson G, Jurasic MM, Poggensee L, Echevarria K, et al. Antibiotic prophylaxis prescriptions prior to dental visits in the Veterans’ Health Administration (VHA), 2015–2019. Infect Control Hosp Epidemiol. 2022;43(11):1565–74.
Suda KJ, Calip GS, Zhou J, Rowan S, Gross AE, Hershow RC, et al. Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Netw Open. 2019;2(5):1–15.
Thornhill MH, Gibson TB, Durkin MJ, Dayer MJ, Lockhart PB, O’Gara PT, et al. Prescribing of antibiotic prophylaxis to prevent infective endocarditis. J Am Dent Assoc. 2020;151(11):835-845.e31.
Thornhill MH, Crum A, Campbell R, Stone T, Lee EC, Bradburn M, et al. Temporal association between invasive procedures and infective endocarditis. Heart. 2022;109(3):223–31.
Gong CL, Duong A, Zangwill KM. Estimating the cost of inappropriate antibiotic prophylaxis prior to dental procedures. Infect Control Hosp Epidemiol. 2023;400:1–4.
U.S. Department of Health and Human Services. Center for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States. 2013. Available at: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf.
Franklin M, Wailoo A, Dayer MJ, Jones S, Prendergast B, Baddour LM, et al. The cost-effectiveness of antibiotic prophylaxis for patients at risk of infective endocarditis. Circulation. 2016;134(20):1568–78.
Shah ASV, McAllister DA, Gallacher P, Astengo F, Rodríguez Pérez JA, Hall J, et al. Incidence, microbiology, and outcomes in patients hospitalized with infective endocarditis. Circulation. 2020;141(25):2067–77.
Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, et al. Infective endocarditis among high-risk individuals before and after the cessation of antibiotic prophylaxis in Dentistry: a national cohort study. Clin Infect Dis. 2022;75(7):1171–8.
Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, et al. Endocarditis, invasive dental procedures, and antibiotic prophylaxis efficacy in US Medicaid patients. Oral Dis. 2023;1–15.
Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, et al. Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. J Am Coll Cardiol. 2022;80(11):1029–41.
Author information
Authors and Affiliations
Contributions
MP and AW wrote the manuscript text and MP prepared tables. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Pries-Heje, M.M., Bundgaard, H., Iversen, K.K. et al. Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines. Curr Cardiol Rep 25, 1873–1881 (2023). https://doi.org/10.1007/s11886-023-02002-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11886-023-02002-5