Infective Endocarditis Prophylaxis Research Articles

Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves

ObjectivePatients with structural abnormalities of cardiac valves, including bicuspid aortic valve (BAV), are said to be at higher risk of infective endocarditis (IE). We sought to determine the risk of...

Antibiotic prophylaxis for infective endocarditis: some rarely addressed issues.

Although quite consistent indications on antibiotic prophylaxis for infective endocarditis (IE) have been reported internationally, several common dental practice issues are still not clear: which dental procedures require antibiotic prophylaxis? In the case of multiple procedures can the same antibiotic be used? How can dentists identify high-risk conditions for IE? Do dentists verify patient antibiotic intake? What are the requirements of antibiotic prophylaxis in cases of coexistence of diseases which involve host defence impairment? What are the modalities of second choice drug administration? And finally, are chlorhexidine mouthwashes before dental procedures combined with antibiotics useful or not? Uncertainty also persists as far as the real need for prophylaxis is concerned and although several sources have suggested that a wide prospective randomised controlled study may be the definitive solution, problems exist in performing such a study.

Are Adults with Congenital Heart Disease Informed about Their Risk for Infective Endocarditis and Treated in Accordance to Current Guidelines?

Background: Infective endocarditis (IE) is associated with significant morbidity and mortality. Adults with congenital heart disease (ACHD) have an increased risk for developing IE. In the last decade the guideline recommendations for antibiotic prophylaxis of IE have changed substantially. Whether and to what extent those changes have been implemented into clinical practice is unknown. Especially the knowledge level of patients has not been studied.

Is endocarditis prophylaxis for dental procedures necessary?

ObjectivesOur purpose is to address whether antimicrobial prophylaxis is necessary before certain dental procedures for patients at increased risk for acquiring infective endocarditis (IE).MethodsWe reviewed recommendations for IE prophylaxis made...

Interactive clinical case: to give, or not to give, infective endocarditis prophylaxis

The practice of prophylactic use of antibiotics before certain procedures for preventing infective endocarditis (IE) is not based on rigorous scientific data. It seems reasonable, however, to offer prophylactic antibiotics...

KNOWLEDGE AND AWARENESS REGARDING ANTIBIOTIC PROPHYLAXIS FOR INFECTIVE ENDOCARDITIS AMONG UNDERGRADUATE DENTAL STUDENTS

<p>ABSTRACT<br />Objective: To evaluate the knowledge and awareness regarding antibiotic prophylaxis for infective endocarditis (IE) among undergraduate dental<br />students.<br />Methods: A validated questionnaire of 16 questions, regarding the basic knowledge and awareness about antibiotic prophylaxis for the prevention<br />of IE, was distributed among 100 students randomly belonging to final year and internship (5<br /> year trainee) of the undergraduate dental program in<br />Saveetha Dental College and Hospital, Saveetha University, Chennai. The data extracted were tabulated, statistically analyzed, and results obtained.<br />Results were calculated on the basis of frequency and percentages using SPSS Version 20.0.<br />th<br />Results: About 73% of the students were aware of IE prophylaxis, and 40% of dental students were exposed to treating patients susceptible to IE.<br />56% of participants answered that amoxicillin is the first line of antibiotic for IE prophylaxis and 59% replied 2 g PO 1 hr before the appointment is<br />the recommended regimen. 36% said that erythromycin is no longer recommended by American Heart Association for IE prophylaxis. However, only<br />one-third of the participants knew about the cardiac conditions and dental procedures that require antibiotic prophylaxis for the prevention of IE.<br />Furthermore, only 16% knew about the recommended dosage of clindamycin.<br />Conclusion: This study revealed a reasonable knowledge and awareness about IE prophylaxis among undergraduate dental students but was<br />inadequate. Hence, this study emphasizes the need for improved education in the teaching curriculum for dental students regarding IE prophylaxis.<br />A standard protocol regarding the training as well as preventive measures for IE should be formulated for the dental students and the knowledge<br />acquired must be transferred into practice.<br />Keywords: Infective endocarditis, Prophylaxis, Antibiotics, Dental students, Knowledge.</p>

Trends in infective endocarditis hospitalisations at United States children's hospitals from 2003 to 2014: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines.

National organisations in several countries have recently released more restrictive guidelines for infective endocarditis prophylaxis, including the American Heart Association 2007 guidelines. Initial studies demonstrated no change in infective endocarditis rates over time; however, a recent United Kingdom study suggested an increase; current paediatric trends are unknown. Children (5 years of age. Interrupted time series analysis was used to evaluate rates over time indexed to total hospitalisations. A total of 841 cases were identified. The median age was 13 years (interquartile range 9-15 years). In the pre-guideline period, there was a slight increase in the rate of infective endocarditis by 0.13 cases/10,000 hospitalisations per semi-annual period. In the post-guideline period, the rate of infective endocarditis increased by 0.12 cases/10,000 hospitalisations per semi-annual period. There was no significant difference in the rate of change in the pre- versus post-guidelines period (p=0.895). Secondary analyses in children >5 years of age with CHD and in children hospitalised with any type of infective endocarditis at any age revealed similar results. We found no significant change in infective endocarditis hospitalisation rates associated with revised prophylaxis guidelines over 11 years across 29 United States children's hospitals.

The causative agents in infective endocarditis: a systematic review comprising 33,214 cases.

Infective endocarditis (IE) incidence remains high with considerable fatality rates; guidelines for prophylaxis against IE are currently under review in some settings which highlights the importance of maintaining up-to-date epidemiological estimates about the most common microbial causes. The objective of this systematic review, following PRISMA guidelines, was to identify the most common microbial causes of IE in recent years. Medline was searched from January 1, 2003 to March 31, 2013 for all articles containing the term "infective endocarditis". All relevant studies reporting diagnostic results were included. Special patient subpopulations were assessed separately. A total of 105 studies were included, from 36 countries, with available data on a total of 33,214 cases. Staphylococcus aureus was found to be the most common microorganism, being the most frequent in 54.3% of studies (N = 57) (and in 55.4% of studies using Duke's criteria for diagnosis [N = 51]). Viridans group streptococci (VGS), coagulase-negative staphylococci (CoNS), Enterococcus spp and Streptococcus bovis were among the most common causes. S. aureus was the most common pathogen in almost all population subgroups; however, this was not the case in patients with implantable devices, prosthetic valves, or immunocompromised non-HIV, as well as in the sub-group from Asia, emphasizing that a global one-size-fits-all approach to the management of suspected IE is not appropriate. This review provides an evidence-based map of the most common causative agents of IE, highlighting S. aureus as the leading cause in the 21st century. The changing epidemiology of IE in some patient sub-groups in the last decade and the very high number of microbiologically undiagnosed cases (26.6%) suggest the need to revisit IE prophylaxis and diagnostic strategies.

RISK FACTORS FOR INFECTIVE ENDOCARDITIS IN SURGICAL PATIENTS WITH BICUSPID AORTIC VALVE DISEASE

Bicuspid aortic valve (BAV) disease is associated with an increased risk of infective endocarditis (IE) compared to the general population. Although prior studies have estimated a 10-30% risk of IE in BAV disease, antibiotic prophylaxis for IE is no longer recommended in these patients. Few studies

Infective Endocarditis Hospitalizations Before and After the 2007 American Heart Association Prophylaxis Guidelines

BackgroundIn 2007, the American Heart Association (AHA) published revised guidelines for infective endocarditis (IE) prophylaxis. Population-based data with respect to the potential impact of these revised guidelines are lacking. MethodsThe Canadian Institute for Health Information Discharge Abstract Database was used to identify all hospitalizations between April 2002 and March 2013 having IE as a primary diagnosis. Hospitalization rates were determined using age-specific population data from Statistics Canada. Interrupted time series analysis was used to evaluate changes in the slope of hospitalization rates after the AHA guidelines were published. ResultsThere were 9431 hospitalizations during the study period among 8055 patients (63% male patients). Time trend analysis showed an increase of 0.05 IE hospitalizations per 10 million population per month (95% confidence interval, 0.005-0.09; P = 0.029) from April 2002-March 2007 and an increase of 0.07 IE hospitalizations per 10 million population per month from April 2007-March 2013 (interaction P = 0.5213). Change-point analysis showed that a change in the slope occurred in April 2011, 4 years after publication of the revised AHA guidelines. Staphylococcus aureus was the most commonly reported organism (29.4%). Streptococcal infections decreased over time, beginning before the 2007 guidelines (P < 0.0001). The presence of a pacemaker or defibrillator was an increasingly prevalent risk factor over time (4% increase per year; P = 0.0178). ConclusionsThe rate of IE hospitalizations increased in Canada before and after the publication of the 2007 AHA guidelines, with no significant change in slope after 2007. These guidelines had no impact on the incidence of IE hospitalizations.

Infective endocarditis prophylaxis in patients undergoing oral surgery

Infective endocarditis (IE), an infection of the endocardium that usually involves the valves and adjacent structures, may be caused by a wide variety of bacteria and fungi that entered the bloodstream and settled in the heart lining, a heart valve or a blood vessel. The IE is uncommon, but people with some heart conditions have a greater risk of developing it. Despite advances in medical, surgical, and critical care interventions, the IE remains a disease that is associated with considerable morbidity and mortality. Hence, in order to minimize the risk of adverse outcome and achieve a yet better management of complications, it is crucial to increase the awareness of all the prophylactic measures of the IE. For the past 50 years, the guidelines for the IE prophylaxis have been under constant changes. The purpose of this paper is to review current dental and medical literature considering the IE prophylaxis, including the new and updated guidelines from the American Heart Association (AHA, 2007 and 2015), the National Institute for Health and Clinical Excellence (NICE, 2015), the European Society of Cardiology (ESC, 2009 and 2015) and the British Society for Antimicrobial Chemotherapy (BSAC, 2006).

Staphylococcus lugdunensis Endocarditis in a 35-Year-Old Woman in Her 24th Week of Pregnancy.

Background. Infective endocarditis is associated with considerable morbidity and mortality. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. This is the first published report of infective endocarditis by Staphylococcus lugdunensis in a pregnant woman. Case Presentation. We report a single case of a 35-year-old woman in her 24th week of pregnancy who was admitted to our intensive care unit with fever and suspected infectious endocarditis. Blood culture detected Staphylococcus lugdunensis. A vegetation and severe mitral regurgitation due to complete destruction of the valve confirmed the diagnosis. An interdisciplinary panel of cardiologists, maternal-fetal medicine specialists, cardiac and plastic surgeons, infectiologists, anesthesiologists, and neonatologists was formed to determine the best therapeutic strategy. Conclusions. Timing and indications for surgical intervention to prevent embolic complications in infective endocarditis remain controversial. This original case report illustrates how managing infective endocarditis by Staphylococcus lugdunensis particularly in the 24th week of pregnancy can represent a therapeutic challenge to a broad section of specialties across medicine. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child.

Antibiotics prophylaxis for infective endocarditis due to oral procedure. How should you perform in your clinic today?

Antibiotics prophylaxis for infective endocarditis due to oral procedure. How should you perform in your clinic today?

Stuck Mitral Bio-Prosthetic Valve

A 26-year-old lady was evaluated at our hospital for rheumatic mitral valve disease in March 2007. She underwent Mitral Valve Replacement (MVR) with a bio-prosthetic valve (Bio-cor 27 mm) in April 2007. She was discharged on the 9th day with stable hemodynamics and optimized INR values. During follow up she had optimal INR values and normal gradients across the valve. After three months of adequate anticoagulation her warfarin was stopped since she was in sinus rhythm. She continued to take aspirin and remained in sinus rhythm. She was advised infective endocarditis prophylaxis. Eleven months after MVR she developed breathlessness over one week, which gradually worsened to orthopnoea. On admission she had pulmonary edema and the gradients across the bio-prosthetic mitral valve were increased (Maximum of 34 mmHg and Mean of 24 mmHg). Her previous echocardiogram in July 2007 showed normal gradients across the valve. Her transthoracic and transesophageal echocardiograms were suggestive of a stuck mitral prosthesis (Echo figures). There was a mobile membranous structure that appeared like a detached valve apparatus but could not be clearly delineated pre-operatively. We assumed that it was an unstable prosthetic structure. The intra-operative echocardiogram also showed similar features.

Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

Endocarditis - an update

Infective endocarditis remains a diagnostic and therapeutic challenge. This update focuses on recent developments in the diagnostic workup, therapeutic management and prophylaxis of infective endocarditis. Recommendations of the new guidelines of the European Society of Cardiology and the updated statement of the American Heart Association are compared and discussed. The new entity transcatheter aortic valve implantation (TAVI)-associated endocarditis is also highlighted.

Abstract 17235: Trends in Endocarditis Hospitalizations at US Children's Hospitals From 2003-2014: Impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines

Introduction: Over the past decade, national organizations in several countries have released more restrictive guidelines for infective endocarditis (IE) prophylaxis, including the American Heart Association (AHA) 2007 guidelines. Multiple initial studies demonstrated no change in IE rates over time following release of these guidelines, however a more recent analysis over a longer time period in the UK suggested an increase in IE. This prior study primarily included adults. Current IE trends in the pediatric population are unknown. Methods: Children (&lt;18 years) hospitalized with IE at 29 US centers participating in the Pediatric Health Information Systems Database from 2003-2014 were eligible for inclusion. Our primary analysis focused on IE most directly related to the change in the AHA guidelines, and included community-acquired IE cases (antibiotics covering oral streptococcal species started within 7 days of admission) in those &gt;5 years of age (most likely to be receiving dental care). Interrupted time series analysis was used to evaluate IE rates over time indexed to total hospital admissions. Results: A total of 841 IE cases were identified. Median age was 13 years (interquartile range 9-15 years). In the pre-guideline period, the IE rate increased slightly over time (+0.013 IE cases/1000 hospitalizations per 6-month period, see Figure). In the post-guideline period there was a similar trend in IE rates (+0.012 IE cases/1000 hospitalizations per 6-month period) with no significant difference in slope in the pre vs. post period (p=0.9). Additional analyses in those with congenital heart disease, and in those hospitalized with any type of IE (not limited to oral streptococci) at any age, revealed similar results. Conclusions: In contrast to a recent UK study, we found no evidence of a change in IE hospitalization rates associated with revised IE prophylaxis guidelines over an 11 year period across 29 US children’s hospitals.

Dental Procedures and the Risk of Infective Endocarditis.

Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE.Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed.In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54-1.59), 1.64 for surgery (95% CI 0.61-4.42), 0.92 for dental scaling (95% CI 0.59-1.42), 1.69 for periodontal treatment (95% CI 0.88-3.21), and 1.29 for endodontic treatment (95% CI 0.72-2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE.Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based.

Antibiotic prophylaxis for infective endocarditis: Knowledge and implementation of American Heart Association Guidelines among dentists and dental hygienists in Alberta, Canada

BackgroundKnowledge and interpretation of the 2007 American Heart Association (AHA) guidelines regarding infective endocarditis (IE) prophylaxis among the dental community is not well established. The authors’ aim was to determine how dentists and dental hygienists interpret the 2007 AHA guidelines. MethodsThe authors sent a cross-sectional survey to a random sample of 450 dental hygienists and 450 dentists in Alberta, Canada. The survey ascertained whether the practitioner would recommend IE prophylaxis to a high-risk cardiac patient undergoing a variety of dental procedures and for a variety of cardiac lesions in patients requiring gingival manipulation. ResultsOne hundred forty-nine hygienists (33%) and 194 dentists (43%) completed the survey. Use of prophylaxis for specific dental procedures was heterogeneous; 43% of hygienists recommended prophylaxis for polishing, 46% did not, and 11% replied “sometimes.” Hygienists were more likely than dentists to inappropriately recommend IE prophylaxis for low-risk lesions including mitral valve prolapse (54% of hygienists versus 42% of dentists recommending prophylaxis; P = .037) and hypertrophic cardiomyopathy (23% versus 15%; P = .057). The authors also observed a failure to recommend IE prophylaxis for high-risk lesions, including mechanical valve (that is, 81% of hygienists and 91% of dentists recommending prophylaxis; P = .008). ConclusionsThere is heterogeneity within the dental community with respect to IE prophylaxis. Dental hygienists are more likely than dentists to recommend IE prophylaxis for low-risk cardiac lesions. Both dentists and hygienists did not consistently recommend prophylaxis for all high-risk cardiac lesions. Practical ImplicationsGreater emphasis on IE prophylaxis education is required in training programs and continuing professional development.

Congenital bicuspid aortic valve: steps toward providing an answer to the question of antibiotic endocarditis prophylaxis

We report a case of congenital bicuspid aortic valve infective endocarditis in an 18-year-old male with no significant past medical history. He presented to the emergency department from an ophthalmology clinic with new right-eye vision changes. Initial EKG revealed sinus tachycardia and he was hemodynamically stable. Expedited diagnostic transesophageal echocardiography revealed vegetations on both aortic leaflets, an aortic root abscess, and a fistulous tract extending from the left ventricular outflow tract into the right ventricular outflow tract. Although he was evaluated by the cardiothoracic surgery team and scheduled for operative repair, he acutely became bradycardic, developed pulseless electrical activity, and was resuscitated on multiple occasions, but died suddenly from PEA arrest within 24 hours of presenting to the emergency department. This case demonstrates complications of acute bacterial endocarditis. We discuss the current debate surrounding the role of antibiotic prophylaxis for infective endocarditis. Additionally, we suggest that patients with a bicuspid aortic valve, a common congenital defect with a known increased risk for bacterial endocarditis, might represent a unique cohort to prospectively study whether antibiotic prophylaxis reduces the incidence, morbidity, and mortality of bacterial endocarditis in patients at increased risk.