Downloaded from http://heart.bmj.com/ on June 20, 2015 - Published by group.bmj.com
PostScript
CORRESPONDENCE
Response to comment on: The infective endocarditis team: recommendations from an international working group by San Roman et al To the Editor, We thank Dr San Roman and colleagues for their comment1 on our editorial.2 They suggest that all cases with endocarditis should be referred to a reference centre because the specialist expertise to monitor their progress may not be available at general hospitals. The typical length of intravenous antibiotic therapy for patients with endocarditis is 4–6 weeks, and beds in most cardiac centres are limited, so it is necessary to manage their use carefully. Some patients are unlikely to need cardiac surgery, for example, those with uncomplicated endocarditis caused by fully sensitive oral streptococci or those with right-sided endocarditis. It should be safe to manage these kinds of patients at a general hospital, provided there are close links with the cardiac centre including case discussions by telephone and review of echocardiography via a shared archive. Other patients, after a period of inpatient medical therapy with or without surgical intervention, can be managed by the reference centre as outpatients with close monitoring of continued intravenous therapy and periodic evaluation for persistent infection or complications. Clearly, local variations in practice should evolve including specialists from the surgical centre visiting the general hospital, temporary transfer to the cardiac centre for a day for a transoesophageal echocardiogram if indicated and formulation of a management plan. If close links between the centre and the general hospital are not feasible and if sufficient beds are available, then management of all cases at the centre is reasonable.
162
The key to optimal treatment implicit in both our editorial and in the comment by Dr San Roman et al is that endocarditis requires specialist involvement at presentation and at all stages of inpatient and subsequent outpatient care. John B Chambers,1 Jonathan Sandoe,2 Simon Ray,3 Bernard Prendergast,4 Chris Arden,5 Jo Wilson,6 Brian Campbell,7 Christa Gohlke-Baerwolf,8 Carlos A Mestres,9 Raphael Rosenhek,10 Phillippe Pibarot,11 Catherine M Otto12 1
Cardiothoracic Centre, Guys and St Thomas Hospitals, London, UK British Infection Association, Leeds, UK 3 British Cardiovascular Society, London, UK 4 British Cardiovascular Society 5 Royal College of General Practitioners 6 British Assoc of Nursing for Cardiac Care 7 Society for Cardiological Science and Technology 8 Herz-Zentrum Bad Krozingen, Germany 9 Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Spain 10 Medical University of Vienna, Vienna, Austria 11 Quebec Heart and Lung Institute, Quebec City, Canada 12 University of Washington Seattle, USA 2
Correspondence to Dr John B Chambers, St Thomas Hospital, London SE1 7EH, UK; [email protected] Contributors JBC wrote the draft and the other authors contributed comments or made changes that were incorporated in the final version. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Chambers JB, Sandoe J, Ray S, et al. Heart 2015;101:162. Received 22 October 2014 Accepted 23 October 2014 Published Online First 28 November 2014
▸ http://dx.doi.org/10.1136/heartjnl-2014-306230 Heart 2015;101:162. doi:10.1136/heartjnl-2014-307048
Heart January 2015 Vol 101 No 2
REFERENCES 1
2
San Román JA, Vilacosta I, López J. Comments on: “The infective endocarditis team: recommendations from an international working group. Heart 2014;100:1301–2. Chambers J, Sandoe J, Ray S, et al. The infective endocarditis team: recommendations from an international working group. Heart 2014;100: 524–7.
Downloaded from http://heart.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Response to comment on: The infective endocarditis team: recommendations from an international working group by San Roman et al John B Chambers, Jonathan Sandoe, Simon Ray, Bernard Prendergast, Chris Arden, Jo Wilson, Brian Campbell, Christa Gohlke-Baerwolf, Carlos A Mestres, Raphael Rosenhek, Phillippe Pibarot and Catherine M Otto Heart 2015 101: 162 originally published online November 28, 2014
doi: 10.1136/heartjnl-2014-307048 Updated information and services can be found at: http://heart.bmj.com/content/101/2/162.3
These include:
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript
CORRESPONDENCE
Response to comment on: The infective endocarditis team: recommendations from an international working group by San Roman et al To the Editor, We thank Dr San Roman and colleagues for their comment1 on our editorial.2 They suggest that all cases with endocarditis should be referred to a reference centre because the specialist expertise to monitor their progress may not be available at general hospitals. The typical length of intravenous antibiotic therapy for patients with endocarditis is 4–6 weeks, and beds in most cardiac centres are limited, so it is necessary to manage their use carefully. Some patients are unlikely to need cardiac surgery, for example, those with uncomplicated endocarditis caused by fully sensitive oral streptococci or those with right-sided endocarditis. It should be safe to manage these kinds of patients at a general hospital, provided there are close links with the cardiac centre including case discussions by telephone and review of echocardiography via a shared archive. Other patients, after a period of inpatient medical therapy with or without surgical intervention, can be managed by the reference centre as outpatients with close monitoring of continued intravenous therapy and periodic evaluation for persistent infection or complications. Clearly, local variations in practice should evolve including specialists from the surgical centre visiting the general hospital, temporary transfer to the cardiac centre for a day for a transoesophageal echocardiogram if indicated and formulation of a management plan. If close links between the centre and the general hospital are not feasible and if sufficient beds are available, then management of all cases at the centre is reasonable.
162
The key to optimal treatment implicit in both our editorial and in the comment by Dr San Roman et al is that endocarditis requires specialist involvement at presentation and at all stages of inpatient and subsequent outpatient care. John B Chambers,1 Jonathan Sandoe,2 Simon Ray,3 Bernard Prendergast,4 Chris Arden,5 Jo Wilson,6 Brian Campbell,7 Christa Gohlke-Baerwolf,8 Carlos A Mestres,9 Raphael Rosenhek,10 Phillippe Pibarot,11 Catherine M Otto12 1
Cardiothoracic Centre, Guys and St Thomas Hospitals, London, UK British Infection Association, Leeds, UK 3 British Cardiovascular Society, London, UK 4 British Cardiovascular Society 5 Royal College of General Practitioners 6 British Assoc of Nursing for Cardiac Care 7 Society for Cardiological Science and Technology 8 Herz-Zentrum Bad Krozingen, Germany 9 Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Spain 10 Medical University of Vienna, Vienna, Austria 11 Quebec Heart and Lung Institute, Quebec City, Canada 12 University of Washington Seattle, USA 2
Correspondence to Dr John B Chambers, St Thomas Hospital, London SE1 7EH, UK; [email protected] Contributors JBC wrote the draft and the other authors contributed comments or made changes that were incorporated in the final version. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Chambers JB, Sandoe J, Ray S, et al. Heart 2015;101:162. Received 22 October 2014 Accepted 23 October 2014 Published Online First 28 November 2014
▸ http://dx.doi.org/10.1136/heartjnl-2014-306230 Heart 2015;101:162. doi:10.1136/heartjnl-2014-307048
Heart January 2015 Vol 101 No 2
REFERENCES 1
2
San Román JA, Vilacosta I, López J. Comments on: “The infective endocarditis team: recommendations from an international working group. Heart 2014;100:1301–2. Chambers J, Sandoe J, Ray S, et al. The infective endocarditis team: recommendations from an international working group. Heart 2014;100: 524–7.
Downloaded from http://heart.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Response to comment on: The infective endocarditis team: recommendations from an international working group by San Roman et al John B Chambers, Jonathan Sandoe, Simon Ray, Bernard Prendergast, Chris Arden, Jo Wilson, Brian Campbell, Christa Gohlke-Baerwolf, Carlos A Mestres, Raphael Rosenhek, Phillippe Pibarot and Catherine M Otto Heart 2015 101: 162 originally published online November 28, 2014
doi: 10.1136/heartjnl-2014-307048 Updated information and services can be found at: http://heart.bmj.com/content/101/2/162.3
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
