Multivalvular Bacterial Endocarditis After Suction Curettage Abortion

Abstract

Dr. Jeppson et al recently reported a young apparently healthy woman who developed endometritis after an elective abortion at 16 weeks of gestation. She later developed bacterial endocarditis and subsequently died. The patients against endometritis was a postoperative prescription for doxycycline twice daily for 3 days. The authors conclude that this case highlights the importance of administering the correct antibiotic for surgical site-related infections more than 1 hour before or at the time of surgery. They reason that if the patients risk of endometritis was decreased it may have decreased the risk of endocarditis. The American Heart Association (AHA) does not recommend antibiotic for infective endocarditis prevention for genitourinary procedures because no studies exist that demonstrate that the administration of antimicrobial prevents [infective endocarditis] in association with procedures performed on the [gastrointestinal] or [genitourinary] tract. Likewise the National Institute for Health and Clinical Excellence (United Kingdom) longer recommends antibiotic to prevent infective endocarditis during gynecologic procedures. Unfortunately definitive correct antibiotic prophylaxis exists to prevent postabortal endometritis. The study cited to support the authors recommended timing of antibiotics analyzed major orthopedic colon and vascular surgeries in a Veterans Administration setting. The cited meta-analysis examined 12 studies using 10 different antibiotic regimens. The American College of Obstetricians and Gynecologists Practice Bulletin Number 74 suggests two regimens for antimicrobial during induced abortion/dilation and curettage: oral doxycycline 100 mg 1 hour preoperatively and 200 mg postoperatively or metronidazole 500 mg twice daily for 5 days (postoperative therapy only). Case reports that propose wide-ranging conclusions based on a single rare unfortunate outcome are unhelpful. Contrary to the authors statements there is consensus that postabortal endometritis must be administered pre-procedure and expert consensus from the AHA that abortion does not warrant endocarditis prophylaxis. We will stick to AHA guidelines for prevention of endocarditis and await further controlled research on regimens to prevent postabortal endometritis. (full-text)