Endocarditis Prophylaxis Research Articles

Is there an indication for endocarditis prophylaxis in patients with cardiac devices?

Cardiac implantable electronic devices (CIED) are essential in treating cardiovascular disease, but their infections are serious complications. The number of patients with CIEDs is increasing, as are CIED infection rates and related endocarditis. These infections arise either from contamination during implantation or from secondary infections. Current guidelines do not support prophylactic antibiotics for CIED patients before dental or other invasive procedures, unless the patient has other risk factors (E.g. an artificial heart valve). Patients with fever or signs of a pocket infection should be treated in centers equipped for laser extraction.

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Assessment of endocarditis prophylaxis knowledge and attitudes among healthcare practitioners in Tehran and Hamadan

BackgroundHaving knowledge of the dental procedures that necessitate endocarditis prophylaxis is of high importance. Therefore, the aim of the present study was to determine the knowledge level and attitudes of general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan about endocarditis.MethodsThis cross-sectional study was carried out on 420 general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan provinces in 2015. The questionnaire used in this research consisted of three parts as follows: part one: information on cardiac diseases; part two: dental procedures requiring endocarditis prophylaxis; part three: antibiotic diet in endocarditis prophylaxis. Independent t-test, one-way ANOVA, and chi-square tests were conducted to analyze the data. All the analyses were performed in SPSS version 16.ResultsThe results showed that 86.7 had a relatively favorable and 10.5% of subjects had a favorable level of knowledge about endocarditis. Also, 58.6% of subjects had a poor attitude toward endocarditis prophylaxis. There was a significant relationship between knowledge and attitude, age, gender, and work experience (P < 0.001). There was a significant relationship between knowledge and attitude, and job groups; dental specialists had a more favorable knowledge and positive attitude than others (P < 0.001).ConclusionWe recommended developing more practical training programs in dental schools on cardiac diseases, and dental procedures requiring endocarditis prophylaxis and antibiotic diets.

Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

Melody transcatheter pulmonary valve replacement: a single-center case series in Southeast Asia

BackgroundStudies of transcatheter pulmonary valve replacement (TPVR) with the Melody valve have demonstrated good clinical and hemodynamic outcomes. Our study analyzes the midterm clinical and hemodynamic outcomes for patients who underwent Melody valve implantation in Southeast Asia.MethodsPatients with circumferential conduits or bioprosthetic valves and experiencing post-operative right ventricular outflow tract (RVOT) dysfunction were recruited for Melody TPVR.ResultsOur cohort (n = 14) was evenly divided between pediatric and adult patients. The median age was 19 years (8–38 years), a male-to-female ratio of 6:1 with a median follow-up period of 48 months (16–79 months), and the smallest patient was an 8-year-old boy weighing 18 kg. All TPVR procedures were uneventful and successful with no immediate mortality or conduit rupture. The primary implant indication was combined stenosis and regurgitation. The average conduit diameter was 21 ± 2.3 mm. Concomitant pre-stenting was done in 71.4% of the patients without Melody valve stent fractures (MSFs). Implanted valve size included 22-mm (64.3%), 20-mm (14.3%), and 18-mm (21.4%). After TPVR, the mean gradient across the RVOT was significantly reduced from 41 mmHg (10–48 mmHg) to 16 mmHg (6–35 mmHg) at discharge, p < 0.01. Late follow-up infective endocarditis (IE) was diagnosed in 2 patients (14.3%). Overall freedom from IE was 86% at 79 months follow-up. Three patients (21.4%) developed progressive RVOT gradients.ConclusionFor patients in Southeast Asia with RVOT dysfunction, Melody TPVR outcomes are similar to those reported for patients in the US in terms of hemodynamic and clinical improvements. A pre-stenting strategy was adopted and no MSFs were observed. Post-implantation residual stenosis and progressive stenosis of the RVOT require long term monitoring and reintervention. Lastly, IE remained a concern despite vigorous prevention and peri-procedural bacterial endocarditis prophylaxis.

The level of knowledge of medical and dental students regarding prophylaxis for infective endocarditis.

Infective endocarditis is a rarely seen disease, but has a high mortality rate. Therefore, it is extremely important that the guidelines are followed correctly. The main aim of this study was to evaluate and compare the level of knowledge and attitude of infective endocarditis of fourth- and fifth-year dentistry students in clinical residency and fifth- and sixth-year medical students. A 42-item questionnaire evaluating the type and dosage of antibiotics administered as infective endocarditis prophylaxis in medical conditions and dentistry procedures was delivered online to the study participants. The data obtained were examined using descriptive statistics and analyzed with the chi-square test. The questionnaire was completed by a total of 332 participants. The statistical analyses showed a good level of knowledge in 55% of the dentistry faculty students and in 43.5% of the medical faculty students. When considering that dental and medical faculty students are not expected to receive additional training on antimicrobial management after graduation, the findings of this study have raised significant attitude for the improvement of our education system in this field.

Anaesthetic Management of a Pregnant Lady with Epstein Anomaly

Wilhelm Ebstein first described the clinical and anatomical features of an anomaly of the tricuspid valve in 1866, which occurs in 1 percent of congenital heart defects (1 in 110,000 of the general population). It is characterized by dysplastic abnormalities of both basal and free attachments of the tricuspid valve leaflets, with downward displacement and elongation of the septal and anterior cusp, with resulting tricuspid regurgitation. Congestive heart failure and sudden collapse are the most common causes of death Case Report: A 21 year old primi with 37 wks gestation was referred to our hospital for complicated pregnancy management. She complained of occasional palpitations, and dyspnoea on severe exertion. She had no history of recurrent chest infections, cyanosis or heart failure in the past. On examination she had pansystolic and mid-diastolic murmurs with right parasternal thrill, along with widely split second heart sound. The ECG showed sinus rhythm with right bundle branch block. Chest X-ray showed enlarged right atrium with cardiomegaly, while echocardiogram showed the presence of moderately enlarged right atrium, tricuspid regurgitation with downwardly displaced tricuspid valves, confirming diagnosis of Ebstein’s anomaly. Her blood reports were within normal limits. We kept ready all routine and emergency drugs and equipments. Subsequently she was shifted into the OT, monitors were attached, and given antibiotics for bacterial endocarditis prophylaxis. A sitting epidural was tried at L3-4 interspace. INJ bupivacaine 0.5% 15cc given in graded doses of 5 cc every 5 minutes by monitoring hemodynamic response. Level achieved till T6. Thereafter left lateral tilt and oxygen were continuously administered to the patient. Intraoperatively her vitals were stable and duration of operation was 60 minutes and a female baby of birth weight 2.4kg was extracted. Postoperatively the patient vitals were stable. Conclusion: In conclusion, women with Ebstein’s anomaly may present with a multitude of problems and, should be considered as high risk and cared for in tertiary centres by a multidisciplinary team including obstetricians, cardiologists and obstetric anaesthetists in pregnancy and during delivery. Epidural anaesthesia in a fractionated or ‘graded’ manner provides a haemodynamically stable patient with adequate analgesia, and may be preferred to general anaesthesia in these patients.

Antibiotic-Prescribing Habits in Dentistry: A Questionnaire-Based Study.

A ten-question survey was administered to a group of Italian dentists. The participants were asked about their preferences for antibiotic administration for the prevention of infective endocarditis, the administration of antibiotics to patients allergic to penicillin, the insertion of implants, and the extraction of third molars. The retrieved data were screened and analyzed. A total of 298 surveys were filled out. The most-prescribed antibiotic was amoxicillin or amoxicillin with clavulanic acid or macrolides for allergic patients. The administration of two grams of amoxicillin one hour before surgery was the most widely used prescriptive protocol for prophylaxis. International guidelines on antibiotic prophylaxis for infective endocarditis were only partially followed. The most heterogeneous results emerged for prophylaxis associated with dental implants or provided prior to surgical third-molar extraction. The present study shows widespread antibiotic prescriptive heterogeneity among the sample of dentists analyzed, especially in conditions where international guidelines are lacking. An evidence-based consensus on prescriptive modalities in dentistry would be desirable in the near future.

Unveiling the Knowledge Gap Regarding Standard Antibiotic Prophylaxis for Infective Endocarditis Among Physicians, Dentists and Cardiologists in Pakistan: A Cross-Sectional Study.

Infective endocarditis is a microbial infection of the endocardial surface of the native and prosthetic valves. This study aimed to evaluate knowledge regarding the current guidelines for antibiotic prophylaxis for infective endocarditis. This cross-sectional study was conducted among physicians, cardiologists, and dentists in Rawalpindi and Islamabad. The questionnaire was distributed as Google Forms among the required population, and responses were collected on a Google Response Sheet. The participants viewed rheumatic heart disease (83.7%) and heart transplant (96.7%) as the most vulnerable conditions that warrant the need for antibiotic prophylaxis. The other questions yielded average responses. The findings of this study emphasize the importance of adhering to standard guidelines and highlight the need for knowledge of the current guidelines.

Patients with Artificial Heart Valves.

In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising. We summarize the current state of the prophylaxis, diagnosis, and treatment of prosthetic endocarditis in a selective review of the literature. Prosthetic endocarditis accounts for 10-30% of all cases of endocarditis. As its echocardiographic and microbiologic findings are often less specific than those of native endocarditis, its diagnosis now increasingly relies on alternative imaging modalities such as F-18-FDG PET-CT. Anti-infective and surgical treatment are made more difficult by biofilm formation on the prosthetic valve and the frequent formation of perivalvular abscesses. Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.

Medical Consultations, A Neglected Topic in Periodontology: A Cross-sectional Study

Aim: To evaluate in detail the consultation forms of patients presenting to the periodontal department of a dental faculty hospital.&#x0D; Material and method: The forms were analyzed in two parts: the consultation request and the response. Demographic data and the department for which consultation was requested were evaluated in the request part. In the response section, precautions taken during dental treatment (antibiotic prophylaxis, etc.) were investigated. The readability and repetition of the consultation were also studied.&#x0D; Results: The analysis was performed on 505 forms from 430 patients. Recommendations for antibiotic prophylaxis, preventive medication, or change of medication regimen were made in 50.3% of the forms. Antibiotic prophylaxis was recommended in 68 forms (13.5%). Of the recommended infective endocarditis prophylaxis, 38.9% were by American Heart Association guidelines. In the readability evaluation, 93.7% of the request sections were understood at the first reading, while the readability level of the response was 66.9%. It was seen that 47 forms (9.3%) were insufficient and repeated.&#x0D; Conclusion: Healthy communication between dental and medical disciplines should be promoted through regular education, and clinicians should be aware of the new guidelines. In addition, medical consultations should be integrated into structured forms or digital workflows.

Antibiotic prophylaxis for infective endocarditis during high-risk gastrointestinal procedures

Antibiotic prophylaxis for infective endocarditis during high-risk gastrointestinal procedures

Early Counseling to Improve Oral Health Behavior in Children with Major Congenital Heart Defects: A Randomized Controlled Trial

Maintaining optimal oral health behavior in children with a congenital heart defect (CHD) is important in managing the risk for caries development and infective endocarditis. The aim of this study was to evaluate the impact of an early and repeat oral health promotion intervention (OHPI) among children with major CHD. Randomized controlled trial including 72 out of 91 children born in Finland April 1, 2017–October 31, 2020 with (a) major CHD potentially included in the criteria of endocarditis prophylaxis or (b) any CHD with surgical repair combined with a chromosomal syndrome. A parallel passive control (C) group of 87 healthy children were recruited at birth. CHD children were randomized 1:1 to intervention (CHD-I) and control (CHD-C) groups. The OHPI included counseling by motivational interviewing, home delivered toothpaste and toothbrushes, and written information, and was provided at baseline, 6, 12, and 18 months of age to CHD-I group. The primary outcome measure at 24 months was child’s oral health behavior (toothbrushing, sugar intake, and dental care contact). The secondary outcome measures were parents’ awareness of the importance of oral health behavior, and oral health behavior as a predictor for child behavior. At 24 months, toothbrushing was performed twice a day in 20/27 (74%) among CHD-I, in 13/30 (43%) among CHD-C (CHD-I vs. CHD-C p = 0.03), and in 37/50 (74%) among healthy comparisons (CHD-C vs. C p = 0.01). Electric toothbrush use was 12/27 (44%) in CHD-I, 5/30 (17%) in CHD-C (CHD-I vs. CHD-C p = 0.04), and 7/50 (14%) in healthy comparison (CHD-C vs. C p = 0.76) children. Among CHD-I, toothbrushing and use of electric toothbrush improved between 12 months and 24 months. Sugar drink intake was more common among CHD-C (CHD-C vs. C p = 0.02), but comparable to CHD-I children. Parental toothbrushing predicted child toothbrushing twice a day. There were no statistical group differences in dental care contact. Children with CHD are at risk for poor oral health behavior. This could be improved with early and repeat oral health promotion parental counseling.

CULTURE NEGATIVE INFECTIVE ENDOCARDITIS – A CASE SERIES IN A TEACHING HOSPITAL IN RURAL INDIA

Background- Infective endocarditis (IE) is an infection of endocardial surface of the heart. It commonly involves heart valves but may also involve other endocardial sites in heart. The incidence is 3 to 10 per one lakh with mortality of 30%. Viridian streptococci and staph aureus are common causative organism, 6% of cases are culture negative IE. Aims and Objectives-To report 5 cases of culture negative infective endocarditis and to study predisposing factors, response to treatment and outcome. Materials And Methods-The study was conducted in patients admitted in Department of Pediatrics, Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital ,Loni from January 2022 to June 2022 and diagnosed as IE by modied Duke's criteria, detailed history was taken to assess the risk factors and clinical examination, 2d echocardiography, serial blood culture, careful monitoring is done to look for response treatment and outcome. Results- During the study period total 8 cases were diagnosed as infective endocarditis out of which 5 cases were found to be culture negative IE.Out of 5 cases, 4 patient had congenital heart disease and 1 patient had RHD as predisposing factor,4 survived and 1 patient expired.3 patient responded to empirical antibiotic treatment, while 1 patient was reffered to higher center for surgery due to failure of medical management. Conclusion-Infective endocarditis prophylaxis in patient with risk factors is appropriate step in prevention and proper blood culture technique , prompt clinical examination and imaging remains the mainstay in diagnosis of IE.Antibiotic policy according to the protocol and 2d echocardiographical surveillance reects the outcome.

Oral health behavior during early childhood in children with major congenital heart defects.

Good oral health in children with congenital heart defect (CHD) is important. To assess oral health behavior during early childhood in children with CHD in comparison with children with no known systemic conditions and to explore parental oral health behavior associated with children's behavior. Seventy of all 89 children born in Finland between April 1, 2017, and March 31, 2020, with (a) major CHD potentially included in the criteria of endocarditis prophylaxis or (b) any CHD with surgical repair combined with a chromosomal syndrome, and a comparison group of 87 children with no known systemic conditions were recruited. Thirty-five children with CHD were randomized to usual care (no intensified counseling) and were compared with 87 matched comparison children by a parental questionnaire assessing child and parental oral health behavior at child age at 24 months. Toothbrushing twice a day (p=.008) and the use of fluoride toothpaste twice a day (p=.059) were less common in children with CHD than in children in the comparison group. Nonwater drinks between meals was more common among children in the CHD group than in the comparison group (p=.015). Children with major CHD experience poorer oral health behavior in comparison with children with no known systemic conditions during early childhood.

Antibiotics in Labor and Delivery

Infections are common in obstetric care and often require specific antibiotics, depending on the infection site and prevailing organisms. Summaries of antibiotic recommendations and treatment algorithms are provided for the following conditions: routine labor, group B streptococcus prophylaxis, preterm prelabor rupture of membranes, operative vaginal delivery, cesarean delivery, obstetric anal sphincter lacerations, chorioamnionitis, postpartum endometritis, infections of the urinary tract, and bacterial endocarditis prophylaxis.

Periodontal Disease in Association with Myocardial Infarction with Non-Obstructive Coronary Arteries and Microvascular Coronary Artery Disease

BackgroundThe relationship between periodontitis and myocardial infarction with non-obstructive coronary arteries (MINOCA) and microvascular angina has not been previously investigated. Hence, the present study aimed to elucidate the association between periodontitis in patients with angina despite non-obstructive coronary artery disease (CAD). In addition, we compared the prevalence of periodontitis in the age-matched general population with no CVD or CV risk factors. MethodsThis prospective observational study included patients diagnosed with MINOCA by screening electronic records of all the ACS patients (n=103,955) from January 2018 to December 2021. All patients diagnosed with MINOCA were enrolled as group 1 and age-matched controls with no CAD were labelled as group 2. Those with recent periodontal treatment and endocarditis prophylaxis were excluded. Univariate and multivariate regression analyses were performed to determine independent predictors of MINOCA and severe periodontitis. ResultsThe study population comprised 6,237 patients with MINOCA (group 1) and 6,000 age-matched healthy adults (group 2) who had no major cardiovascular events. Female gender (odds ratio [OR]: 1.04, 95% confidence interval [CI]: [0.93 – 1.59], p=0.004), diabetes mellitus (OR: 0.25, [0.05 – 0.63], p=0.02), peripheral arterial disease (OR: 0.78, [0.63 – 0.91], p=0.001), dyslipidaemia (OR: 1.45, [0.47 – 2.93], p=0.015), smoking, moderate (OR: 5.42, [1.91 – 22.69], p=0.04) and severe periodontitis (OR: 2.58, [1.72 – 3.26], p=0.027) were independent predictors of MINOCA. ConclusionThe present study, for the first time, demonstrated an independent association between moderate to severe periodontitis and the increased incidence of MINOCA among the general population.

Antibiotic prescription after tooth extraction in adults: a retrospective cohort study in Austria

BackgroundBroad spectrum antibiotics are often used for the prophylaxis of infectious endocarditis and treatment of odontogenic infections, but there are limited data related to antibiotic use and adherence to prescription guidelines. MethodsData from patients with tooth extraction between 2014 and 2018 were selected from a database of a regional health insurance fund. We created three data sets, one based on all tooth extractions, one on multiple teeth extractions, and one including only single tooth extraction. After data collection, descriptive analysis was carried out. The differences in prescription pattern of antibiotic medicine were tested by χ2 test, Student´s t-test or ANOVA.ResultsFrom 43,863 patients with tooth extraction, 53% were female, and 3,983 patients (9.1%) filled a prescription for antibiotic medicine. From 43,863 patients, 157 patients (0.4%) had endocarditis risk, but only 8 patients of these (5.1%) filled an antibiotic prescription. In total, 9,234 patients had multiple and 34,437 patients had only one tooth extraction. Patients with more than one tooth extraction received more often antibiotic treatment (10.7%) compared to those with single tooth extractions (χ2 = 36; p < 0,001). Patients with more than one tooth extraction were older, however, younger patients received antibiotics more frequently (t = 28,774, p = 0.001). There was no relationship with endocarditis risk status. Clindamycin and amoxicillin/clavulanic acid were the most frequently prescribed antibiotic medicines.ConclusionsIn this retrospective cohort study, dentists did not discriminate prophylactic antibiotic prescription with regard to endocarditis risk status. A factor influencing prescribing behaviour of antibiotic medicines was the number of extracted teeth.

Early Empiric Antibiotic Treatment Among Neonates With Congenital Heart Defects: A Brief Report of an Integrative Review

OBJECTIVES: Despite improved rates of survival, neonates with congenital heart defects experience serious comorbidities. Antibiotics are used widely in other critically ill neonates, and exposure in the first 7 days after birth (early empiric antibiotic treatment) has been associated with increased risk of adverse outcomes. The purpose of this brief report is to summarize and evaluate existing evidence pertaining to early empiric antibiotic treatment and associations with adverse outcomes among neonates with congenital heart defects. DESIGN: An integrative review of the literature was performed. SETTING: The search was conducted in PubMed and Ovid Medline, and Global Health databases. Medical Subject Headings terms and Boolean phrases were used. SUBJECTS: Original research articles were included if the study cohort neonates with congenital heart defects, were published in English, and included a description or evaluation of early empiric antibiotic treatment in the first 28 days of life. Endocarditis and postoperative antibiotic prophylaxis investigations were excluded. MAIN RESULTS: Our search generated 249 articles. Search results were listed in an Excel spreadsheet and screened by four authors. Articles that did not pertain to the population of interest were excluded. Fourteen articles were included in the full-text review. Data from these articles were summarized in a table and evaluated by all authors. No articles were found discussing early empiric antibiotic treatment in neonates with congenital heart defects. LIMITATIONS: Our search generated no results, impairing our ability to fulfill the purpose of the brief report. CONCLUSIONS: There have been no studies regarding early empiric antibiotic treatment among neonates with congenital heart defects. Research is needed to understand the prevalence, indications, and potential consequences of early empiric antibiotic treatment in this population.

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?: A Cochrane Review Summary With Commentary.

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?: A Cochrane Review Summary With Commentary.