A critical appraisal of the quality of the management of infective endocarditis

OBJECTIVES. The purpose of this study was to assess the quality of the management of infective endocarditis. BACKGROUND. Although many guidelines on the managementof infective endocarditis exist, the quality of this management has not been evaluated. METHODS. We collected data on all patients (116) hospitalized with infective endocarditis over 1 year in all hospitals in the Rhone-Alpes region (France). RESULTS. Prophylactic antibiotics were not-given before infective endocarditis to 8/11 cardiac patients at risk and who underwent an at risk procedure. Among the 55 cardiac patients at risk and with fever and who consulted a physician, blood cultures were not performed before antibiotic therapy was initiated for 32 patients. In-hospital antibiotic therapy was incorrect for 23 patients. The portal of entry was not treated for 16/61 patients with an accessible portal of entry. Among the 19 patients who had severe heart failure or fever persisting more than 2 weeks in spite of antibiotic therapy and who could have undergone early surgery, surgery was delayed for five, and not performed for three. Overall, the average score was 15/20. CONCLUSIONS. More information on the management of infective endocarditis should be widely disseminated to the physicians' and the dentists' communities and to the patients at risk. (C) 1999 by the American College of Cardiology.