Management of infective endocarditis in a secondary care trust: a service evaluation of treatment outcomes and multidisciplinary involvement.

Background. Infective endocarditis (IE) is a complex and life-threatening condition, requiring multidisciplinary team (MDT) input for optimal management. Objectives. This study aimed to review the demographics, infection management and clinical outcomes of patients treated for IE at Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), a secondary care provider in London. This study evaluated local IE service provision against national and international guidelines to identify areas for service improvement. Methods. A retrospective cohort study was conducted, identifying adult patients (≥18 years) treated for IE at CWFT between September 2023 and August 2024. Patients who received >10 days of intravenous amoxicillin, flucloxacillin, cefazolin or vancomycin were screened. Patients who received a full course of IE treatment were included. Clinical records were reviewed for demographic, microbiological, imaging, MDT involvement and clinical outcome data. Results. Thirty-one patients met the inclusion criteria. The median age was 77 years (interquartile range 53-85), and 74% were male. Staphylococcus aureus (35%) and Enterococcus faecalis (29%) were the most common pathogens. Only 12 patients (39%) were discussed at a cardiothoracic MDT, and 2 patients lacked cardiology input. Microbiology consultations occurred in all cases, but only 55% had documented antimicrobial plans. Outpatient therapy was used in 36% of cases. Adverse outcomes of IE treatment included in-hospital mortality in 12.9% (n=4) and decline in functional baseline in 29% (n=9). Conclusions. Whilst key treatment standards were largely met, gaps in MDT involvement and documentation were identified. Implementation of a dedicated IE MDT may increase adherence to guidelines and improve secondary care service provision.