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CC BY 4.0 · Thorac Cardiovasc Surg 2025; 73(S 03): e46-e52
DOI: 10.1055/a-2731-5261
Pediatric and Congenital Cardiology

Update after 2023 ESC Guidelines for the Management of Infective Endocarditis (IE) – Regarding the National IE Guideline of the German Society of Pediatric Cardiology

Authors

  • Walter Knirsch 

    1   Division of Pediatric Cardiology, Pediatric Heart Center, Children's Research Center, University Children's Hospital Zurich, Switzerland
    2   University of Zurich, Zurich, Switzerland

  • Colin R. MacKenzie

    3   Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany

  • Hans-Joachim Schäfers

    4   Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany

  • Ruth Heying

    5   Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Belgium

  • Oktay Tutarel

    6   Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany

  • Carsten Rickers

    7   University Heart and Vascular Center, Adult Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Introduction

In 2023, new guidelines of the European Society of Cardiology (ESC) for the management of infective endocarditis (IE) were published.[1] These new 2023 ESC Guidelines also include changes in the management of IE in pediatric and adult patients with congenital heart disease (CHD). Therefore, we intend to comment on changes in comparison with the national German IE Guideline of the German Society of Pediatric Cardiology from 2022[1] by incorporating the new ESC Guideline a(https://register.awmf.org/de/leitlinien/detail/023-024).

The preceding ESC Guidelines were published in 2015,[2] and the following reasons led to the remake of 2023:

  • Increasing population at risk for IE

  • New data on different clinical scenarios in patients with IE

  • Increasing resistance of antibiotics for oral streptococci

  • The impact of new diagnostic modalities, including CT/nuclear imaging techniques, especially for patients with prosthetic valves and implantable cardiac devices.

Within the new 2023 ESC Guidelines, a large number of revised or new recommendations (>20) were summarized in an extensive publication (>100 pages, >850 references), including an update on antibiotic treatment. A paradigm change opens perspective for new optional outpatient and oral antibiotic treatment following 2 weeks of intravenous antibiotic treatment in stable (adult) patients with IE due to non-difficult-to-treat microorganisms.[1]

Within this comment, the authors of the national German Guideline summarize and discuss the most important new or revised recommendations with a focus on IE in pediatric or adult patients with CHD.

a Knirsch W, MacKenzie CR, Schäfers HJ, Heying B, Tutarel O, Rickers C. Infektiöse Endokarditis und Endokarditisprophylaxe. Leitlinie der DGPK (beschlossen 28.09.2022) http://www.kinderkardiologie.org/Leitlinien




Publication History

Received: 03 April 2025

Accepted: 03 August 2025

Article published online:
23 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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