Prevention Of Endocarditis Research Articles

Antibacterial Therapy and Prevention of Infectious Endocarditis in Modern Conditions

The problem of infectious endocarditis (IE) still retains its importance due to high mortality rates and the development of severe complications. Modern IE is a polyethological disease, the occurrence and development of which can be caused by pathogens that make up an extremely extensive list, which is updated almost annually. At the same time, serious obstacles standing in the way of effective antimicrobial therapy are both the increasing resistance of IE pathogens to antibiotics and the increasing etiological role of infectious agents that were previously very rare. This article presents the basic principles of treatment and prevention of IE, taking into account the latest recommendations of the experts of the European Society of Cardiology in 2023.

Development of a Patient and Clinician Informed Website on Injection Drug Use Related Infective Endocarditis.

Few patient-facing educational materials and interventions exist for the prevention of injection drug use-related infective endocarditis (IDU-IE). We developed a patient and clinician-informed website for patients about IDU-IE to promote education and prevention strategies. This mixed-methods study integrated surveys and semi-structured interviews with patients and clinician to develop a patient website about IDU-IE. Patient participants included hospitalized adults with an opioid use disorder, history of injection drug use, and an injection drug use-related infection. Interprofessional healthcare clinicians including trainees participated. A baseline survey and semi-structured interviews were conducted with patients to understand knowledge of IDU-IE and preferences in educational materials content and format. Interviews were analyzed using rapid qualitative analysis. Results informed development of the patient website. Finally, patients and clinicians provided 2 rounds of survey feedback after reviewing the website, assessing the likelihood of using and recommending it to others, helpfulness of information in the website sections, and content satisfaction. Patient participants (n = 15) reported low baseline understanding of injection practice and risk of IDU-IE. After reviewing the website (n = 17), patients reported they were very likely to recommend the website as a reference for themselves (mean of 4.3; 4 = very likely) and for others (mean = 4.3). They found the following sections, on average, to be very helpful (4 = very helpful): complications from injection drug use (4.4), safer injection practice (4.4), and information about infective endocarditis (4.4). Patients on average were satisfied with the website content overall (4.8). Clinicians (n = 27) reported, on average, being very likely to recommend this website to a patient (4.4) and to use the website to counsel patients (4.1). A patient and clinician-informed website on IDU-IE is acceptable for patients and clinicians to use as a patient education resource to help prevent IDU-IE-related harms.

Antimicrobial envelopes and endocarditis: innovative solutions for CIEDs infection

Abstract Introduction Endocarditis recurrence in patients with cardiac implantable electronic devices (CIEDs) remains a serious concern, demanding effective preventive measures. There is not always the possibility of extraction with a contralateral implant or the implantation of innovative devices. In recent years, two innovative technologies, TYRX and CanGaroo, have emerged as promising solutions to reduce the risk of endocarditis recurrence and improve patient outcomes. TYRX and CanGaroo are two cutting-edge medical technologies designed to address a critical concern in the management of patients with cardiac implantable electronic devices (CIEDs): the prevention and treatment of infected pockets. Both TYRX and CanGaroo offer unique approaches to mitigate this risk and improve patient outcomes. The TYRX is composed of a mesh envelope containing two antimicrobial agents, minocycline, and rifampin, that providing local and sustained delivery of antimicrobial agents directly at the device pocket. Instead, the primary function of the CanGaroo is to create a physical barrier between the CIED and the surrounding tissues, reducing the risk of bacterial contamination. The CanGaroo is particularly valuable in cases where patients have a higher risk of endocarditis recurrence due to underlying health conditions, compromised immune systems, or previous episodes of infection. By minimizing the direct contact between the CIED and adjacent tissues, the CanGaroo helps reduce the risk of bacterial adherence and biofilm formation. Objectives Educate the patient and caregiver to recognize signs of infection and avoid contamination. Improve training and education of cardiology nurse specialists for the prevention and recurrence of endocarditis on intra-operative management using these new devices and the post-operative course. Materials and Methods Database research and field evaluations. Outcome and Discussion TYRX and CanGaroo are groundbreaking technologies that demonstrate the potential to reduce the recurrence of endocarditis in patients with CIEDs. Their innovative designs and positive clinical outcomes highlight their importance as valuable tools in infection prevention strategies for CIED recipients. Conclusion Both TYRX and CanGaroo offer innovative approaches to prevent endocarditis recurrence in patients with CIEDs. By utilizing their unique mechanisms, these devices contribute to a multi-pronged infection prevention strategy. The TYRX envelope's localized antimicrobial delivery and the CanGaroo envelope's physical protection complement standard infection control measures during implantation. It is important to note that while TYRX and CanGaroo offer significant advances in infection prevention, they are not standalone solutions. A comprehensive approach, including stringent infection control protocols, patient selection, and diligent post-implantation monitoring, is crucial in reducing the risk of endocarditis recurrence effectively.tryx

Prevention of infective endocarditis in at-risk patients: how should dentists proceed in 2024?

National Institute for Health and Care Excellence (NICE) guidelines are ambiguous over the need for patients at increased risk of infective endocarditis (IE) to receive antibiotic prophylaxis (AP) prior to invasive dental procedures (IDPs), and this has caused confusion for patients and dentists alike. Moreover, the current law on consent requires clinicians to ensure that patients are made aware of any material risk they might be exposed to by any proposed dental treatment and what can be done to ameliorate this risk, so that the patient can decide for themselves how they wish to proceed. The aim of this article is to provide dentists with the latest information on the IE-risk posed by IDPs to different patient populations (the general population and those defined as being at moderate or high risk of IE), and data on the effectiveness of AP in reducing the IE risk in these populations. This provides the information dentists need to facilitate the informed consent discussions they are legally required to have with patients at increased risk of IE about the risks posed by IDPs and how this can be minimised. The article also provides practical information and advice for dentists on how to manage patients at increased IE risk who present for dental treatment.

New evidence calls into question NICE's endocarditis prevention guidance

In 2008, National Institute for Health and Care Excellence (NICE) guidelines recommended against the use of antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent infective endocarditis (IE). They did so because of lack of AP efficacy evidence and adverse reaction concerns. Consequently, NICE concluded AP was not cost-effective and should not be recommended. In 2015, NICE reviewed its guidance and continued to recommend against AP. However, it subsequently changed its wording to ‘antibiotic prophylaxis against infective endocarditis is not routinely recommended'. The lack of explanation of what constituted routinely (and not routinely), or how to manage non-routine patients, caused enormous confusion and NICE remained out of step with all major international guideline committees who continued to recommend AP for those at high risk.Since the 2015 guideline review, new data have confirmed an association between IDPs and subsequent IE and demonstrated AP efficacy in reducing IE risk following IDPs in high-risk patients. New evidence also shows that in high-risk patients, the IE risk following IDPs substantially exceeds any adverse reaction risk, and that AP is therefore highly cost-effective. Given the new evidence, a NICE guideline review would seem appropriate so that UK high-risk patients can receive the same protection afforded high-risk patients in the rest of the world.

Talaromyces marneffei endocarditis initially detected by Next Generation Sequencing: A case report

BackgroundTalaromyces marneffei (T. marneffei) is a thermal dimorphic fungus, which can cause lung or blood stream infection in patients, often life-threatening. However, endocarditis caused by T. marneffei has not been reported. For elderly patients with implanted cardiac devices or artificial valves, the prevention and treatment of infective endocarditis should not be ignored. MethodsThis is a descriptive study of a T. marneffei endocarditis by joint detection of cardiac ultrasound examination, peripheral blood DNA metagenomics Next Generation Sequencing (mNGS), and in vitro culture. ResultsWe describe an 80-year-old female patient with an unusual infection of T. marneffei endocarditis. After intravenous drip of 0.2 g voriconazole twice a day for antifungal treatment, the patient showed no signs of improvement and their family refused further treatment. ConclusionInfective endocarditis is becoming more and more common in the elderly due to the widely use of invasive surgical procedures and implantation of intracardiac devices. The diagnosis and treatment of T. marneffei endocarditis is challenging because of its rarity. Here, we discussed a case of T. marneffei endocarditis, and emphasized the role of mNGS in early diagnosis, which is of great significance for treatment and survival rate of patients.

Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019.

The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts. Cross-sectional analysis of 2019 Veterans' Affairs (VA) national electronic health record data. Antibiotics prescribed by dentists were evaluated for appropriateness based on 2 definitions: one derived from current guidelines (consensus-based recommendations) and the other based on relevant clinical literature (nonconsensus). A clustered binomial logistic regression model determined factors associated with discordant prescribing. In total, 92,224 antibiotic prescriptions (63% amoxicillin; mean supply, 8.0 days) were associated with 88,539 dental visits. Prophylaxis for complications in medically compromised patients was associated with the most (30.9%) antibiotic prescriptions, followed by prevention of postsurgical complications (20.1%) and infective endocarditis (18.0%). At the visit level, 15,476 (17.5%) met the consensus-based definition for appropriate antibiotic usage and 56,946 (64.3%) met the nonconsensus definition. More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. Regardless of definition applied, antibiotics prescribed by dentists were commonly unnecessary. Improving prescribing by dentists is critical to reach the national goal to decrease unnecessary antibiotic use.

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.

Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines.

The question of antibiotic prophylaxis and its role in prevention of infective endocarditis (IE) remains controversial, with differing recommendations from international societies. The aim of this review was to compare and contrast current recommendations on antibiotic prophylaxis for IE by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) and highlight the evidence supporting these recommendations. International guidelines for administration of antibiotic prophylaxis for prevention of IE are largely unchanged since 2009. Studies on the impact of the more restrictive antibiotic prophylaxis recommendations are conflicting, with several studies suggesting lack of adherence to current guidance from the ESC (2015), NICE (2016), and AHA (2021). The question of antibiotic prophylaxis in patients with IE remains controversial, with differing recommendations from international societies. Despite the change in guidelines more than 15years ago, lack of adherence to current guidelines persists. Due to the lack of high-quality evidence and the conflicting results from observational studies along with the lack of randomized clinical trials, the question of whether to recommend antibiotic prophylaxis or not in certain patient populations remains unanswered and remains largely based on expert consensus opinion.

Surgical site infection and perioperative antibiotics in dermatosurgery

Postoperative wound infections represent the most common complication in dermatosurgery. Given the low incidence and heterogeneous data, no standards for perioperative antibiotic prophylaxis (PAP) have been established in clinical practice. To summarize the current evidence on risk factors for postoperative wound infection in dermatosurgery and the new recommendations on PAP. Relevant study data and current recommendations were summarized descriptively. Current evidence suggests that the following factors are associated with an increased risk of wound infection after dermatosurgical procedures: surgery to the lower extremity or the ear, postoperative hemorrhage, defect closure by flap or skin graft, large wound defect, immunosuppression, and male sex. Probably not affecting the risk of infection are diabetes, obesity, age, smoking, use of ablood thinner, multiple surgeries, or wound healing by second intention. Not all risk factors affect the risk of infection equally. They must be weighted differently and only in combination do they increase the risk of wound infection in aclinically relevant way. According to acurrent position paper of the German Society for Dermatosurgery, the indication for PAP should be made individually and only if multiple factors are present. Furthermore, patients with increased risk for bacterial endocarditis or hematogenic endoprosthesis infection should receive PAP prior to septic skin surgery. In dermatologic surgery, PAP should be restricted to patients at high risk for wound infection. Further indications are the prevention of bacterial endocarditis and hematogenic endoprosthesis infection in high-risk individuals prior to septic surgery.

Nondental Invasive Procedures and Risk of Infective Endocarditis: Time for a Revisit: A Science Advisory From the American Heart Association.

There have been no published prospective randomized clinical trials that have: (1) established an association between invasive dental and nondental invasive procedures and risk of infective endocarditis; or (2) defined the efficacy and safety of antibiotic prophylaxis administered in the setting of invasive procedures in the prevention of infective endocarditis in high-risk patients. Moreover, previous observational studies that examined the association of nondental invasive procedures with the risk of infective endocarditis have been limited by inadequate sample size. They have typically focused on a few potential at-risk surgical and nonsurgical invasive procedures. However, recent investigations from Sweden and England that used nationwide databases and demonstrated an association between nondental invasive procedures, and the subsequent development of infective endocarditis (in particular, in high-risk patients with infective endocarditis) prompted the development of the current science advisory.

Assessment of the current knowledge about infective endocarditis prevention among dental hygienists in Italy: A national survey.

To date, there is a lack of data regarding the acceptance of the guidelines for infective endocarditis (IE) prevention among dentists in Italy, and similarly, there are no data on the understanding and compliance of those among dental hygienists (DH). Thus, we tried to assess the ability of DH to recognize and manage categories of patients at high risk of EI, to identify which dental procedures are at increased risk and to assess the level of knowledge of doses and how antibiotic prophylaxis should be administered in specific cases. An anonymous questionnaire was prepared and made accessible online by sharing a Google Forms® link; general personal data and educational background information were collected to obtain a profile of the participants. A total of 362 DH answered to our web-based survey, showing a prevalent female percentage (86.7%) and the most represented age group of 30-39 years old (43.1%). Regarding the gender differences, there were not overall statistically significant differences; similarly, we did not find any differences regarding the overall number of wrong questions if considering the different ages of the participant and the year of graduation. Graduates in Northern Italy have mistaken fewer questions than graduates in other geographical areas. To the best of our knowledge, this is the largest survey about the knowledge of IE for DH ever performed. Because the overprescription of antibiotics contributes to the development of drug resistance, antibiotic stewardship should be at the forefront of patient care. Our data reflect the need for placing a greater emphasis on IE prophylaxis education in training and during continuing professional development events for DH.

Healthcare-associated infective endocarditis: source of infection and burden of previous healthcare exposure.

Prevention of healthcare-associated infective endocarditis (HAIE) is based on characterization of underlying factors. Our object was to describe the source of infection, microbiological etiology, and healthcare-related risk factors for HAIE. Retrospective population-based study. Adult patients diagnosed with HAIE during 2013-2017 who resided in the study area in Southern Finland with adult population of 0.9 million. Ninety-five HAIE episodes were included. Ten episodes were related to cardiac surgery. Of the remaining 85 episodes, 11 were classified as nosocomial (ie, acquired and diagnosed during ongoing hospitalization) and 74 as non-nosocomial HAIE. Staphylococcus aureus caused 45% of nosocomial episodes, but only 16% of non-nosocomial episodes (P = 0.039). Most common sources of infection in non-nosocomial HAIE were previous hospitalization (24%), dialysis (18%), and urologic procedures (15%). Enterococcus spp. caused 23% of non-nosocomial HAIE, and more than half of them were associated with urologic or gastrointestinal procedures. Two-thirds of the non-nosocomial HAIE patients had recent hospitalization or invasive procedure. We counted previous healthcare-related risk factors for IE and those who had two or more of them had higher in-hospital and one-year mortality. Our study indicates the importance of non-nosocomial acquisition of HAIE and S. aureus as the major pathogen in nosocomial episodes. Enterococcal infections dominate in non-nosocomial cases and further studies are needed to identify patients at risk for enterococcal IE after urological or gastrointestinal procedure.

Medical Treatment for Rheumatic Heart Disease: A Narrative Review.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD. Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards. Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis. As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD.

Dealing With Failure.

Dealing With Failure.

Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement From the American Heart Association.

The American Heart Association has sponsored both guidelines and scientific statements that address the diagnosis, management, and prevention of infective endocarditis. As a result of the unprecedented and increasing incidence of infective endocarditis cases among people who inject drugs, the American Heart Association sponsored this original scientific statement. It provides a more in-depth focus on the management of infective endocarditis among this unique population than what has been provided in prior American Heart Association infective endocarditis-related documents. A writing group was named and consisted of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery in October 2021. A literature search was conducted in Embase on November 19, 2021, and multiple terms were used, with 1345 English-language articles identified after removal of duplicates. Management of infective endocarditis in people who inject drugs is complex and requires a unique approach in all aspects of care. Clinicians must appreciate that it requires involvement of a variety of specialists and that consultation by addiction-trained clinicians is as important as that of more traditional members of the endocarditis team to improve infective endocarditis outcomes. Preventive measures are critical in people who inject drugs and are cured of an initial bout of infective endocarditis because they remain at extremely high risk for subsequent bouts of infective endocarditis, regardless of whether injection drug use is continued.

Bicuspid aortic valve and its complications: from molecules to surgery

Bicuspid aortic valve is a relevant condition to the epidemiology of degenerative (stenosis, regurgitation) and infective (endocarditis) aortic valve disease. This review will address the topics of treatment of those valvular complications, focusing on the peculiar aspects distinguishing them from tricuspid aortic valve diseases, in particular transcatheter treatment of stenosis, valve repair/sparing surgery for regurgitation, prevention of endocarditis. Bicuspid aortopathy represents a clinical entity with remarkable prognostic, and likely also pathogenetic, heterogeneity. A deeper understanding of the tissue and molecular factors as well as flow-related and biomechanical aspects of its development and progression could help guiding better risk stratification (identification of more severe forms, prevention of acute aortic dissection), allowing for a personalized therapeutic approach. The present review will also summarize the state of the art about bicuspid aortopathy pathogenesis, moreover forwarding new hypotheses for the interpretation of the many sparse pieces of evidence currently available.

What are the effects of prophylactic antibiotics for the prevention of bacterial endocarditis in dentistry?

What are the effects of prophylactic antibiotics for the prevention of bacterial endocarditis in dentistry?

Risk of infective endocarditis associated with invasive dental procedures in patients with cardiac rhythm devices.

The incidence of infective endocarditis related to cardiac implantable electronic devices (CIEDs) has gradually increased. The risk associated with dental procedures in patients with CIED implantation and the need for prevention of infective endocarditis remain unclear. The present study investigated the incidence and risk of infective endocarditis associated with invasive dental procedures in patients with CIEDs. We analysed a nationwide population-based cohort of patients with CIEDs who underwent dental procedures. We performed a self-controlled case series analysis and evaluated the incidence rate ratio of infective endocarditis 3 months after dental procedures. Of a total of 62 019 patients who underwent CIED implantation, 32 536 patients underwent at least one dental procedure during follow-up, and the mean number of dental procedures was 3.4 per patient. They were 152 infections with an incidence of 445 per 100 000 person-years in the dental procedure period and 500 events at an incidence of 255 per 100 000 person-years in the non-dental procedure period. The CIED-related infective endocarditis in the dental procedure period occurred significantly more frequently than during non-dental procedure periods (odds ratio, 1.75; 95% confidence interval, 1.48-2.05; P < 0.001). The mean time interval from dental procedure to infective endocarditis was 59.6 ± 47.3 days. Invasive dental procedures are associated with an increased risk of infective endocarditis in those who underwent CIED implantation. Appropriate preventive therapy might be needed in these patients.

Prevention of Infective Endocarditis of Oral Origin in Children: A Call for Pediatric Dentists–Pediatric Cardiologists’ Collaboration in Egypt

To assess knowledge and practices of some Egyptian pediatric dentists and pediatric cardiologists/cardiac surgeons regarding prevention of infective endocarditis (IE) from oral origin in children. Pediatric dentists or pediatric cardiologists/cardiac surgeons having their practice in Egypt were conveniently selected. An online questionnaire was constructed for each specialty practitioner in English using a web-based platform. Each survey tool collected data about demographics, knowledge, and practices concerning the prevention of IE of oral origin. Surveys were disseminated to potential respondents using direct messaging or posting surveys' links on high-traffic areas (blogs, groups, or pages) of commonly known social media platforms. Two-hundred and thirty-nine pediatric dentists and 71 pediatric cardiologists/cardiac surgeons' responses were included in analysis. Some shortage in oral health knowledge and deviations in management protocol from known guidelines were evident in cardiologists' responses, whereas 66.2 and 64.8% reported encountering IE of oral origin or canceling a cardiac surgery due to oral infection, respectively. Most pediatric dentists (65.7%) rely on physician referral before managing children at risk of IE despite following recognized guidelines for IE prevention which may reflect difficulty in understanding such guidelines. Ninety percent of children with heart diseases visit a dentist due to oral complaint and not for checkup. Identification of disparities and pitfalls in management of children with heart diseases, if appropriately addressed by pediatric dentists and cardiologists, may reduce the risk of IE from an oral origin. Health education of both specialists and development of national guidelines based on national epidemiology and clinical experience of cardiologists are strongly needed to decrease oral disease burden, allow for a consensus of patient management, and minimize the need for cross-referral, thus facilitating dental management without undue delays.