p.17 抽出テキスト

Heart Valve Centre, a centre having all diagnostic and therapeutic resources to treat IE, the core members of the Endocarditis Team should include cardiologists, cardiovascular surgeons, infectious disease specialists (or internal medicine specialists with expertise in infectious diseases), and microbiologists. Furthermore, for specific clinical questions, cardiologists/surgeons with expertise in CIED extraction, HF, and CHD; pathologists; critical care specialists; cardiac anaesthesiologists; interventional cardiologists; neurologists and neurosurgeons; pharmacologists; radiologists and nuclear medicine specialists; nephrologists; geriatricians; and multidisciplinary addiction medicine teams (psychiatrists, nurses, and social work specialists providing counselling) are crucial adjuncts that should be available onsite for consultation. Specific subgroups of complex and high-risk patients are frequently assessed by the Endocarditis Team. The decision-making process may involve difficult decisions regarding continuation of therapy, and legal counsel may therefore be required.

Cardiovascular imaging has achieved such an advanced sophistication in the diagnosis of IE that the cardiologists with expertise in

N

Start empirical antibiotic treatment

Admission to a Heart Valve Centre Admission to a Referring Centre

Adjust antibiotic treatment according to blood culture results

Patient with definite infective endocarditis 2023 ESC diagnostic criteria

Y

Endocarditis Team Cardiologists Cardiovascular surgeons Infecious disease specialists Microbiologists

Adjunct specialities Radiologists/nuclear medicine specialists Neurologists/ neurosurgeons Intensive care specialists Geriatricians Nephrologists Nurses Addiction medicine teams

Establish indication

and timing of cardiac surgery

Consultation with outpatient antibiotic

therapy team Frequent communication Clinical, microbiological, and imaging data sharing Endocarditis Team Cardiologists Infectious disease specialists

Complicated clinical evolution Unstable haemodynamic condition under pharmacological and/or respiratory support Severe valvular regurgitation (clinical and echocardiographic criteria) Prosthetic valve endocarditis with or without prosthetic valve dysfunction Stroke (ischaemic or haemorrhagic) with definite or possible IE Extravalvular complications (abscesses, fistulae, etc.) Positive blood cultures >7 days under appropriate antibiotic therapy Embolism CIED-related infective endocarditis Aggressive or difficult-to-treat microorganisms (S. aureus, Gram-negative bacilli, fungi)

Figure 3 Management of patients with infective endocarditis: positioning of the Endocarditis Team. CIED, cardiovascular implanted electronic device; ESC, European Society of Cardiology. Downloaded from academic.oup.com/eurheartj/article/44/39/3948/7243107 by guest on 07 October 2026