Recommendations for research

In 2008 the Guideline Committee made 3 recommendations for research.

As part of the 2015 update, the Standing Committee made an additional research recommendation on antibiotic prophylaxis against infective endocarditis. This can be found in the addendum.

1 National register of infective endocarditis

Infective endocarditis is a rare condition. The development of a national register of infective endocarditis in the UK to support research is recommended.

Why this is important

Such research would be facilitated by the availability of a national register that could offer data into the 'case' arm of proposed case‑control studies and should be an anonymised database that would not require patient consent and hence more straightforward case ascertainment. Although it is a rare condition, it is likely that across the country there are enough patients to generate evidence from well conducted national studies.

2 Cardiac conditions and infective endocarditis

What is the risk of developing infective endocarditis in people with acquired valvular disease and structural congenital heart disease?

Why this is important

Such research should use a population‑based cohort study design to allow direct comparison between groups and allow estimation of both relative and absolute risk.

3 Interventional procedures and infective endocarditis

What is the frequency and level of bacteraemia caused by non‑oral daily activities (for example, urination or defaecation)?

Why this is important

Such research should quantitatively determine the frequency and level of bacteraemia.

4 Antibiotic prophylaxis against infective endocarditis

Does antibiotic prophylaxis in those at risk of developing infective endocarditis reduce the incidence of infective endocarditis when given before a defined interventional procedure?

Why this is important

There is limited evidence about the effectiveness of antibiotic prophylaxis in reducing the incidence of infective endocarditis in people at risk of developing infective endocarditis. The current evidence includes very limited data from observational studies with inconclusive findings. The study should be a randomised controlled trial with long‑term follow‑up comparing antibiotic prophylaxis with no antibiotic prophylaxis in adults and children with underlying structural cardiac defects undergoing interventional procedures. Outcomes should include the incidence infective endocarditis in those receiving prophylaxis compared to those not, and the incidence of adverse effects including anaphylaxis.

  • National Institute for Health and Care Excellence (NICE)