Infective endocarditis (IE) is a major public health challenge. In 2019, the estimated incidence of IE was 13.8 cases per 100 000 subjects per year, and IE accounted for 66 300 deaths worldwide.Due to the associated high morbidity and mortality (1723.59 disability-adjusted life years and 0.87 death cases per 100 000 population, respectively), identification of the best preventive strategies has been the focus of research. Since the publication of the 2015 ESC Guidelines for the management of infective endocarditis, mportant new data have been published mandating an update of recommendations. First, the population at risk of IE has increased and new data on IE in different clinical scenarios have arisen. Furthermore, the emerging and increasing antibiotic resistance among oral streptococci is of concern. The rate of resistance to azythromycin and clarithromycin is higher than that to penicillin. Whether changes in national guidelines on the use of antibiotic prophylaxis have resulted in an increase in the incidence of IE remains unclear. It is likely that the increased use of diagnostic tools to diagnose IE is an important contributor to the increase in the incidence of IE. The use of echocardiography has probably increased in patients with positive blood cultures for Enteroccus faecalis, Staphylococcus aureus, or streptococci due to the associated increased risk of IE. In addition, computed tomography (CT) and nuclear imaging techniques have increased the number of definite IE cases particularly among patients with prosthetic valves and implantable cardiac devices.

Data on the contemporary characterization of patients with IE have been taken into consideration to update the recommendations on the diagnosis and management of patients with IE. Furthermore, the recommendations on antibiotic therapy have been updated based on the susceptibility of various microorganisms defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints. Recommendations on outpatient parenteral antibiotic therapy (OPAT) or oral antibiotic treatment have been included based on the results of the Partial Oral Treatment of Endocarditis (POET) randomized trial and other trials.

The main objective of the current Task Force was to provide clear and simple recommendations, assisting healthcare providers in their clinical decision-making. These recommendations were obtained by expert consensus after thorough review of the available literature (see Supplementary data, evidence tables online). An evidence-based scoring system was used, based on a classification of the strength of recommendations and the levels of evidence.

感染性心内膜炎(IE)是一个重大的公共卫生挑战。2019年，IE的估计发病率为13.8例/100000例受试者/年，IE导致全球66300例死亡。由于相关的高发病率和死亡率（每10万人口分别为1723.59个伤残调整生命年和0.87个死亡病例），确定最佳的预防策略一直是研究的重点。自2015年ESC感染性心内膜炎管理指南发布以来，已发表了重要的新数据，要求更新建议。首先，IE危险人群增加，出现了不同临床情景下IE的新数据。此外，口腔链球菌中抗生素耐药性的出现和增加是值得关注的。对阿奇霉素和克拉霉素的耐药率高于青霉素。国家抗生素预防使用指南的变化是否导致IE发病率的增加仍不清楚。诊断IE的工具应用增加很可能是IE发病率增加的重要贡献者。由于IE风险增加，粪肠球菌、金黄色葡萄球菌或链球菌血培养阳性的患者使用超声心动图可能增加。此外，计算机断层扫描(CT)和核成像技术增加了明确IE病例的数量，特别是在使用人工瓣膜和植入式心脏装置的患者中。

考虑了IE患者的当代特征数据，以更新IE患者的诊断和管理建议。此外，根据欧洲药敏试验委员会(EUCAST)临床折点定义的各种微生物的敏感性，更新了抗生素治疗的建议。根据心内膜炎部分口服治疗(POET)随机试验和其他试验的结果，纳入了关于门诊肠外抗生素治疗(OPAT)或口服抗生素治疗的建议。

当前工作组的主要目的是提供明确和简单的建议，帮助医疗保健提供者做出临床决策。这些建议是在对现有文献进行全面审查后通过专家共识获得的（见补充数据、在线证据表）。根据推荐强度和证据等级的分类，使用了基于证据的评分系统。