Prevention of Infective Endocarditis

Abstract

The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

“…This highlights the importance of pre‐TPVI counseling (including a meticulous dental review) and continuous education of patients and families to lower the exposure to portals of infection, as well as the necessity of routine antibiotic prophylaxis before any invasive maneuver. Notwithstanding, patients with Melody valve implantation combine 2 conditions predisposing to a higher rate of IE and a higher risk of adverse outcome from endocarditis: the use of a prosthetic cardiac valve in the setting of a repaired complex congenital heart disease and an unfavorable hemodynamic environment in the vicinity of that prosthesis (which could interfere with complete prosthesis endothelialization) 41. The most recent US and European guidelines on the management of valvular heart diseases recommend antibiotic prophylaxis before dental procedures in patients with prosthetic cardiac valves, including transcatheter‐implanted prostheses 42, 43.…”

CUA Guidelines on antibiotic prophylaxis for urologic procedures

“…Additionally, the American Heart Association no longer recommends urologic prophylaxis to prevent endocarditis in at-risk patients. 25 The adoption of formal antimicrobial stewardship programs (ASPs) in many medical centres will serve to guide the judicious use of antimicrobials for urologic peri-procedural prophylaxis. 26 ASP activities in this regard should be based on a prospective audit and feedback mechanism, the use of antimicrobial order forms, dose optimization strategies, and formulary restriction or pre-authorization for specific procedures, with or without computerized support.…”

ACTINOMYCES NAESLUNDII, A PREVIOUSLY <i>UNDOCUMENTED</i> CAUSE OF INFECTIVE ENDOCARDITIS; WITH LITERARY REVIEW

“…Current guidelines from the American Heart Association (AHA) do recommend antibiotic prophylaxis prior to dental procedures in patients with prosthetic valves. However, the AHA also states the evidence to support the effectiveness of endocarditis prophylaxis is not compelling and is likely to prevent only a tiny proportion of IE cases, at best (Wilson et al, 2007). This case, as well as previously reported cases, indicate that actinomycotic endocarditis is a potentially fatal disease with significant morbidity and mortality.…”