Implementation of the 2015 European Society of Cardiology guidelines for the management of infective endocarditis in the Netherlands

Figures

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  Fig. 1. Flowchart of microbiological tests for infective endocarditis in The Netherlands. IE Infective endocarditis, BC blood cultures, SWAB Stichting Werkgroep Antibiotica Beleid (Dutch Working Party on Antibiotic Policy), PCR polymerase chain reaction. aIf the diagnostic test is not available, send the blood samples and/or blood cultures to a reference laboratory. bSo as not to miss Cutibacterium acnes and/or if blood cultures were drawn while receiving antimicrobial therapy. cBartonella spp. (IgM, IgG), Coxiella burnetii (including indirect immunofluorescent assay phase I IgG), Legionella spp. (IgM, IgG), Mycoplasma spp. (IgM, IgG). dSpecific PCRs: Bartonella spp., Coxiella burnetii, Legionella spp., Mycoplasma spp., Tropheryma whipplei

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  Fig. 2. Flowchart of diagnostic imaging for infective endocarditis in the Netherlands. IE infective endocarditis, TTE transthoracic echocardiogram, TEE transoesophageal echocardiogram, BC blood cultures, 18F‑FDG PET/CT 18F‑fluorodeoxyglucose positron emission tomography computed tomography, SPECT single photon emission computed tomography, CTA computed tomography angiography, ICE intracardiac echocardiogram, SWAB Stichting Werkgroep Antibiotica Beleid (Dutch Working Party on Antibiotic Policy). a[1, 25]. b[26]. cConsider referring to a tertiary referral centre when there is definite IE and one or more of the following: congenital heart disease in pregnancy, prosthetic valve endocarditis, heart failure, perivalvular extension or uncontrolled infection, embolic events or cerebrovascular accident, arrhythmia or conduction disturbances

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  Fig. 3. Different examples of major imaging diagnostic criteria: two cases of positive transoesophageal echocardiogram (a, b), one case of positive 18F‑FDG PET/CT (c, d) and one case of positive cardiac CT (e, f). a A case of a mechanical aortic valve with signs of vegetation (red arrow). The red arrow in b also indicates a vegetation on the aortic valve bioprosthesis, whereas the white arrow indicates a possible abscess of the aortic root. In c (fused PET/CT images) and in d (non-attenuated PET images) the white arrows indicate 18F‑FDG uptake around the aortic valve bioprosthesis as a sign of possible infection. The red arrow in e indicates a vegetation on one of the leaflets of an aortic valve bioprosthesis. Finally, the red arrow in f indicates a mycotic aneurysm alongside the aortic valve bioprosthesis