Satriano Umberto Maria, Nenna Antonio, Spadaccio Cristiano, Pollari Francesco, Fischlein Theodor, Chello Massimo, Nappi Francesco
Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Cardiac surgery, Golden Jubilee National Hospital, Glasgow, UK.
Ann Transl Med. 2020 Dec;8(23):1625. doi: 10.21037/atm-20-5134.
Infective endocarditis (IE) represented over the last year a growing medical and surgical concern. The changes in etiology and demographic of the disease, which now includes also a large proportion of iatrogenic conditions, has prompted new studies and updates in the guideline for IE treatment. The increasing use of intravascular and intracardiac devices has introduced new challenges in terms of both antibiotic resistance and surgical treatment of prosthetic endocarditis. Also, patients with complex congenital heart diseases, intravenous drug abusers and patients with chronic renal failure under hemodialysis have been added to the list of high-risk subjects for IE. Important aspects concerning the establishment of the endocarditis team, the clinical management, the optimal medical therapy and the indication and timing for surgery are arguments of debate and controversy across the literature. In particular, the most adequate strategy to be adopted in the context of concomitant neurological complication remains greatly debated. Despite attempts to standardize the practice in IE, the lack of powered randomized clinical evidence prevented the achievement of a univocal consensus in several aspects of the management of IE. This situation reflects in some differences in the recommendation promoted by the European Society of Cardiology and American Heart Association/American College of Cardiology. In this review, we will compare the European Society of Cardiology and the American Heart Association guidelines and discuss important aspects related to clinical management and indications of for treatment.
在过去一年中，感染性心内膜炎（IE）已成为日益受到关注的医学和外科问题。该疾病的病因和人口统计学特征发生了变化，如今还包括很大比例的医源性疾病，这促使了关于IE治疗指南的新研究和更新。血管内和心内装置的使用增加，在人工瓣膜心内膜炎的抗生素耐药性和外科治疗方面带来了新的挑战。此外，患有复杂先天性心脏病的患者、静脉药物滥用者以及接受血液透析的慢性肾衰竭患者也被列入IE的高危人群名单。关于心内膜炎团队的组建、临床管理、最佳药物治疗以及手术指征和时机等重要方面，在整个文献中都是争论和争议的焦点。特别是，在伴有神经系统并发症的情况下应采用的最适当策略仍存在很大争议。尽管试图规范IE的治疗实践，但由于缺乏有力的随机临床证据，在IE管理的几个方面未能达成明确的共识。这种情况反映在欧洲心脏病学会和美国心脏协会/美国心脏病学会所推荐的内容存在一些差异。在本综述中，我们将比较欧洲心脏病学会和美国心脏协会的指南，并讨论与临床管理和治疗指征相关的重要方面。
