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CardioLogIQ
2023

ESC 2023 Guidelines — Infective Endocarditis

2023 ESC Guidelines for the management of endocarditis

The 2023 guideline widens the diagnostic criteria to take account of modern imaging, formalises the Endocarditis Team, and sets conditions for treatment outside hospital that are narrower than they are often applied in practice.

Imaging is the first question cluster: when echocardiography is insufficient, what CT and nuclear imaging add, and how the findings feed into the diagnostic categories. Prophylaxis is the second — which patients, which procedures, and the prevention measures around cardiac surgery, where screening precedes decolonisation rather than replacing it.

Then management. Outpatient parenteral therapy and oral step-down each have a list of exclusions. Surgical timing is examined in terms of indication and urgency together. Complications have firm negative statements attached, the clearest being that thrombolysis has no place in endocarditis — an embolic limb or cerebral event is managed otherwise.

What is in the bank

112 active questions. Class and level follow the recommendation each question is built from.

Class of recommendation

Class I
69
Class IIa
24
Class IIb
12
Class III
7

Level of evidence

Level A
6
Level B
45
Level C
61

Sample questions

Endocarditis · 2023Class IIILevel C
A 71-year-old man with Streptococcus sanguinis mitral valve endocarditis and a 16 mm mobile vegetation is on day four of appropriate intravenous antibiotics. He develops sudden severe pain in the left leg, which is cold and mottled below the knee with absent popliteal and pedal pulses. He has reduced sensation over the forefoot but preserved motor function and no muscle tenderness, so the limb is acutely ischaemic but still salvageable. Computed tomographic angiography shows an abrupt cut-off of the left popliteal artery with reconstitution below, and no atherosclerotic disease elsewhere. The vascular team's standard pathway for acute limb ischaemia of this grade is catheter-directed thrombolysis. What should be done?
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