New 2023 ESC Guidelines for the management of endocarditis

A succinct summary of the 2023 guidelines on the management of infectious endocarditis of the European Society of Cardiology is presented. Main new aspects are (1) the importance of treating complicated endocarditis at a hospital with an endocarditis team and cardiac surgery, (2) a less restrictive recommendation for antibiotic prophylaxis, which now favors an individualized indication in patients with intermediary risk, e.g. bicuspid aortic valve and degenerative or rheumatic native valve disease, undergoing orodental interventions, while there is a clear recommendation for prophylaxis in high-risk patients (e.g. having prosthetic valves). (3) In patients with left-sided endocarditis caused by streptococci, enterococcus faecalis, staphylococcus aureus, or coagulase-negative staphylococci, who are stable after at least 10 days of in-hospital intravenous appropriate antibiotic therapy, step-down ambulatory (oral or parenteral) further antibiotic therapy is recommended.