Management and follow-up of patients with infective endocarditis: an international cross-sectional survey

doi:10.1016/j.rec.2026.04.001

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Management and follow-up of patients with infective endocarditis: an international cross-sectional survey

Abordaje y seguimiento de los pacientes con endocarditis infecciosa: resultados de una encuesta transversal internacional

Laura Escolà-Vergéa b c d Philipp MathéeBurcu Islerf g hMichele Bartolettii jSiegbert RiegeBrigitte LamykSara Grilloa b cMiguel Villamarína b cPierre TattevinlNuria Fernández-Hidalgoc d m on behalf of the ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES)

a Servicio de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

b Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain

c Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

d Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain

e Division of Infectious Diseases, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Germany

f Infectious Diseases Department, Gold Coast University Hospital, Australia

g Faculty of Health, Medicine and Behavioural Sciences, University of Queensland, Brisbane, Australia

h Department of Medicine, School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Australia

i Department of Biomedical Sciences, Humanitas University, Milan, Italy

j Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

k Université Sorbonne Paris Nord and Université Paris Cité, Inserm Infection Antimicrobials Modelling Evolution (IAME), Hôpitaux Universitaires Paris Seine Saint-Denis, Service de Microbiologie, Bobigny, France

l Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France

m Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d’Hebron, Barcelona, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Campus Hospitalari, Barcelona, Spain

Received on 6 February 2026

Accepted on 13 April 2026

https://doi.org/10.1016/j.rec.2026.04.001

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Keywords

Infective endocarditis

Follow-up

Management

Survey

Clinical practice

Low- and middle-income countries

Abbreviations

LMIC

Abstract

Introduction and objectives: To describe international practices in the management and follow-up of infective endocarditis.

Methods: We conducted an anonymous web-based survey between October 15 and November 15, 2025, disseminated through European Society for Clinical Microbiology and Infectious Diseases (ESCMID) study groups and national and international societies. The questionnaire comprised 7 sections covering endocarditis team and cardiac surgery availability, inpatient management, and follow-up. Responses were described and compared according to country income (chi-square or Fisher’s exact test, P < .05).

Results: In total, 298 respondents from 49 countries completed the survey. An onsite endocarditis team and onsite cardiac surgery were reported by 53% (159) and 67% (200) of respondents, respectively. In addition, 81% of respondents (242) stated that blood cultures were obtained until clearance of bacteremia, and 61% (183) indicated that echocardiography was performed during treatment. Postdischarge follow-up was mainly coordinated by infectious diseases specialists (70% of respondents, 207). Moreover, 56% of respondents (168) reported that a final echocardiogram was performed, and 25% (74) reported that post-treatment blood cultures were performed. Follow-up duration was up to 6 months for 56% of respondents (169) and > 6 months for 44% (129). Centers in high-income countries more frequently had an endocarditis team (138/218 [63%] vs 21/80 [26%]; P < .001), transesophageal echocardiography (210/218 [96%] vs 61/80 [76%]; P < .001), and positron emission tomography-computed tomography (175/218 [80%] vs 36/80 [45%]; P < .001) and performed serial blood cultures (186/218 [85%] vs 56/80 [70%]; P = .007) and post-treatment blood cultures (67/218 [31%] vs 7/80 [9%]; P < .001).

Conclusions: Substantial variability exists in the organization, monitoring, and follow-up of endocarditis. Consensus-based and evidence-informed strategies are needed to harmonize care.