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

Emily G McDonald*, Gloria Aggrey, Abdullah Tarik Aslan, Michael Casias, Nicolas Cortes-Penfield, Mei Qin Denise Dong, Susan Egbert, Brent Footer, Burcu Isler, Madeline King, Mira Maximos, Terence C Wuerz, Ahmed Abdul Azim, Jhongert Alza-Arcila, Anthony D Bai, Michelle Blyth, Tom Boyles, Juan Caceres, Devin Clark, Kusha DavarJustin T Denholm, Graeme Forrest, Bassam Ghanem, Stefan Hagel, Alexandra Hanretty, Fergus Hamilton, Philipp Jent, Minji Kang, Geena Kludjian, Tim Lahey, Jonathan Lapin, Rachael Lee, Timothy Li, Dhara Mehta, Jessica Moore, Clayton Mowrer, Georges Ouellet, Rebecca Reece, Jonathan H Ryder, Alexandre Sanctuaire, James M Sanders, Bobbi Jo Stoner, Jessica M So, Jean-François Tessier, Raghavendra Tirupathi, Steven Y C Tong, Noah Wald-Dickler, Arsheena Yassin, Christina Yen, Brad Spellberg, Todd C Lee*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)


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.

Original languageEnglish
Article numbere2326366
Number of pages17
JournalJAMA Network Open
Issue number7
Publication statusPublished - 31 Jul 2023


  • Adult
  • Humans
  • Consensus
  • Endocarditis/diagnosis
  • Endocarditis, Bacterial/prevention & control
  • Prospective Studies
  • Practice Guidelines as Topic


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