Consensus Statement 

Infectious Diseases

July 31, 2023

Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement

Emily G. McDonald, Gloria Aggrey, Abdullah Tarık Aslan, et al

JAMA Netw Open. 2023;6(7):e2326366. doi:10.1001/jamanetworkopen.2023.26366

Key Points

Question  Using the WikiGuidelines approach to the construct of clinical guidelines, how often can clear recommendations be made in the diagnosis and management of adult bacterial infective endocarditis?

Findings  In this consensus statement, a panel of 51 members found that only 1 of 17 questions had sufficiently high-quality data to allow for a clear recommendation. Oral transitional therapy is at least as effective as intravenous-only therapy for the treatment of infective endocarditis.

Meaning  These findings suggest that a higher quality of evidence needs to be established to guide the diagnosis and management of infective endocarditis.

Abstract

Importance  Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence.

Objective  To create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength.

Evidence Review  This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches.

Findings  A total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)–only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions.

Conclusions and Relevance  In this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed.