Prevention Of Infective Endocarditis Research Articles

Controversies Surrounding Infective Endocarditis Prophylaxis Prior to Dental Procedures

The guiding principles for the prevention of Infective Endocarditis (IE) following dental procedures have been a debatable topic for a long time now. Evidently this has led to numerous amounts of research and consequently dental practitioners from across the world follow different prophylactic treatment regimens. At present, there are a few regimens that various health authorities have endorsed in their respective countries. There is a lack of substantial data in order to determine which regimen is better over the other, and unfortunately, that places the practitioner in a difficult situation to decide the best for his patient.

INFECTIVE ENDOCARDITIS PROPHYLAXIS – CURRENT PRACTICE AMONGST PEDIATRIC CARDIOLOGISTS: ARE WE FOLLOWING 2007 GUIDELINES?

The indications for antibiotics prophylaxis for prevention of Infective endocarditis (IE) have been revised in 2007. A web-based, anonymous survey was conducted in 2013 to evaluate the current practice for IE prophylaxis amongst the pediatric cardiologists. Total 302 responses were received. The

Antibiotic prophylaxis of infective endocarditis in dentistry: clinical approach and controversies.

Infective endocarditis (IE) in high-risk patients is a potentially severe complication which justifies the administration of antibiotics before invasive dental treatment. This literature review presents the current guidelines for antibiotic prophylaxis and discusses the controversial aspects related to the antibiotic administration for prevention of IE. According to the guidelines of the American Heart Association, individuals who are at risk to develop IE following an invasive dental procedure still benefit from antibiotic prophylaxis. In contrast, the guidelines of the National Institute for Health and Clinical Excellence in England and Wales have recommended that prophylactic antibiotic treatment should no longer be performed in any at-risk patient. Bacteraemia following daily routines such as eating and toothbrushing may be a greater risk factor for the development of IE than the transient bacteraemia that follows an invasive dental procedure. However, a single administration of a penicillin derivate 30 to 60 minutes pre-operatively still represents the main prophylactic strategy to prevent bacteraemia. Presently, there is not enough evidence that supports and defines the administration of antibiotics to prevent IE. The authors suggest performing a risk-benefit evaluation in light of the available guidelines before a decision is made about administration.

The role of endoscopy in the evaluation and management of dysphagia

The role of endoscopy in the evaluation and management of dysphagia

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Infective Endocarditis in Children With Congenital Heart Disease

Background— The American Heart Association guidelines for prevention of infective endocarditis (IE) in 2007 reduced the groups of congenital heart disease (CHD) patients for whom antibiotic prophylaxis was indicated. The evidence base in CHD patients is limited. We sought to determine the risk of IE in children with CHD. Methods and Results— We performed a population-based analysis to determine the cumulative incidence and predictors of IE in children (0–18 years) with CHD by the use of the Quebec CHD Database from 1988 to 2010. In 47 518 children with CHD followed for 458 109 patient-years, 185 cases of IE were observed. Cumulative incidence of IE was estimated in the subset of 34 279 children with CHD followed since birth, in whom the risk of IE up to 18 years of age was 6.1/1000 children (95% confidence interval, 5.0–7.5). In a nested case-control analysis, the following CHD lesions were at highest risk of IE in comparison with atrial septal defects (adjusted rate ratio, 95% confidence interval): cyanotic CHD (6.44, 3.95–10.50), endocardial cushion defects (5.47, 2.89–10.36), and left-sided lesions (1.88, 1.01–3.49). Cardiac surgery within 6 months (5.34, 2.49–11.43) and an age of &lt;3 years (3.53, 2.51–4.96; reference, ages 6–18) also conferred an elevated risk of IE. Conclusions— In a large population-based cohort of children with CHD, we documented the cumulative incidence of IE and associated factors. These findings help identify groups of patients who are at the highest risk of developing IE.

Acceptance among and impact on dental practitioners and patients of American Heart Association recommendations for antibiotic prophylaxis

The 2007 American Heart Association (AHA) guidelines for the prevention of infective endocarditis (IE) called for a major reduction in the number of patients recommended for antibiotic prophylaxis (AP) and redefined the dental procedures considered to put these patients at risk of acquiring the infection. The purpose of the authors' study was to determine the acceptance of these changes among and the impact of the changes on dentists and their patients. The authors sent a survey to a random sample of 5,500 dentists in the United States. Ninety-five percent of the 878 respondents indicated that they saw patients who receive AP. More than 75 percent were either satisfied or very satisfied with the AHA guidelines, and the respondents indicated that they believed almost three-quarters of their patients also were pleased. Seventy percent of dentists, however, had patients who took antibiotics before a dental procedure even though the guidelines no longer recommend it. Acceptance of the 2007 guidelines appears to be high, but controversy remains. Additional scientific data are needed to resolve these issues. The 2007 AHA guidelines have greatly simplified the identification of patients who need AP for dental procedures, given that, in general, far fewer people with cardiac abnormalities are considered to be at risk as a result of invasive procedures. Some physicians, however, continue to prescribe antibiotics for some patients whom the AHA no longer considers to need them. Patients also may choose to continue this practice themselves. There is ongoing controversy surrounding this common clinical question in dental practice, and the next guidelines from the AHA may change on the basis of data from future clinical studies.

Assessment of Knowledge of Dental Staff at a Saudi Arabian University Regarding the Prophylaxis for Infective Endocarditis

The use of prophylactic antibiotics for the prevention of infective endocarditis following dental procedures has long been debated and there is still confusion regarding its efficacy. As a result, the prophylactic treatment varies considerably amongst different countries across the world and amongst different dental practitioners. To evaluate the knowledge of dental staff regarding the guidelines for the prevention of infective endocarditis. This was a cross sectional analytical study which included all staff members. A self administered questionnaire was used and responses were "graded" according to the American Heart Association (AHA) guidelines. The response rate was 87% (N=39) and 97% reported to use the AHA guidelines; 66% reported their knowledge was based on previous training and scientific journals. Of those cardiac conditions and dental procedures which required prophylaxis; 47% and 65% chose the correct option, respectively. Penicillin was prescribed as the drug of choice by the majority of respondents. Although almost all staff reported the use of the AHA guidelines, many were not following them. The study emphasizes the need for continuous education and evaluation of this critical aspect of dentistry.

Guía clínica para la prevención de la endocarditis infecciosa

This article sets out the recommendations for the prevention of infective endocarditis (IE), contained in the guidelines developed by the American Heart Association (AHA) and the European Society of Cardiology (ESC), from which the recommendations of the Spanish Society of Paediatric Cardiology and Congenital Heart Disease have been agreed. In recent years, there has been a considerable change in the recommendations for the prevention of IE, mainly due to the lack of evidence on the effectiveness of antibiotic prophylaxis in prevention, and the risk of the development of antibiotic resistance. The main change is a reduction of the indications for antibiotic prophylaxis, both in terms of patients and procedures considered at risk. Clinical practice guidelines and recommendations should assist health professionals in making clinical decisions in their daily practice. However, the ultimate judgment regarding the care of a particular patient must be taken by the physician responsible.

Les endocardites infectieuses chez l’enfant africain subsaharien, étude transversale à propos de 19 cas à Ouagadougou au Burkina Faso

IntroductionInfective endocarditis is a transplant of a microorganism on a most often injured endocardium. It is rare in children. This work aimed to determine the frequency of endocarditis of the child, to describe clinical presentation, data from echocardiography, microbiological profile and clinical course. Patients and methodsFrom May 1 2010 to April 30 2011, we consecutively included children received for infective endocarditis in two medical centers in the city of Ouagadougou: Saint-Camille medical center and teaching hospital Yalgado-Ouedraogo. We investigated the functional and general signs and treatment already received. The physical examination looking for an infectious syndrome, pneumonia, heart failure and entrance doors. Blood cultures, blood count, creatinine, blood chemistry, HIV status, electrocardiogram, chest radiography and cardiac Doppler ultrasound were systematic. The diagnosis of the disease was based on Duke criteria. ResultsNineteen endocarditis in children were reported, that is 1.7% of admissions. The average age was 4.7±2.6 years (extremes: 1 and 14). The sex ratio was 1.7 for girls. The clinical presentation was a common infectious syndrome. Impaired general condition and congestive heart failure were present on admission in six cases, respectively. The front door was dental in nine cases (47.4%), skin in four cases (21%) and ENT in three cases (15.8%). A peripheral vein was implicated in one case. In the two other cases, no front door had been found. HIV serology was positive in four cases. As for the blood cultures, they were positive in 13 cases. The germs found were Streptococcus in 10 cases and staphylococcus in three cases. Echocardiography had revealed vegetations in 18 cases. These vegetations were localized on the mitral in nine cases. Multiple locations were found in four cases. Underlying heart disease was dominated by rheumatic valve disease (68.4%), healthy heart forms were found in two cases. Treatment consisted of antibiotics, antipyretic treatment and that of heart failure as appropriate. The evolution was marked by five deaths (26.3%) in an array of septic shock. Death was more important in congenital heart disease. ConclusionInfective endocarditis of the child is common in our practice. The clinical syndrome is common infectious. Streptococcus and Staphylococcus are the two germs found. The main door is dental. Hence, dental care should be promoted for better prevention of infective endocarditis in our context.

Prophylaxis of Infective Endocarditis: A Different Brazilian Reality?

The incidence of infective endocarditis (IE), a rare disease with high morbidity and mortality, has not undergone a great change over the past decades, despite the advances in diagnosis and treatment. Thus, much effort should be done to reduce the probability of its occurrence. Previously a predominantly streptococcal disease of patients with long-term heart conditions, IE has changed to be a staphylococcal disease of elderly patients suffering from many comorbidities or having intracardiac devices1. The principles of IE antibiotic prophylaxis (IEAP) were developed based on observational studies at the beginning of the twentieth century2. More than half a century ago, the first recommendation of the American Heart Association (AHA) for IE prevention was headed by Thomas Duckett Jones (1899-1954), and was published months after his death3. The AHA recommendation published in 2008, which replaces the one included in the general guidelines of valvular heart diseases, is currently used4,5. The European Society of Cardiology, with its guidelines published in 2012, endorses the new trends6. According to the new concepts, the use of antibiotics for IE prophylaxis before starting dental interventional procedures involving the manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa, should be indicated only for patients at higher risk for the adverse outcome of an episode of IE; thus, their use is not necessary for patients solely at risk for IE. If on the one hand there was a dramatic change in the IEAP proposition - for example, the National Institute for Health and Care Excellence (NICE) recommended the complete cessation of IEAP in Great Britain7 - consequent to reinterpretation of known data, on the other, there was a reduction in the emphasis on the heart condition, chronic rheumatic heart disease, which is highly valued in Brazil. We should, therefore, reflect about the strict adhesion to that renovation. Those proposing a significant restriction justify their position with the scarcity of scientific conclusions about the benefit of preventing the development of IE, reserving IEAP to a minority of cases understood as of preoccupying clinical course. It is worth noting that the new recommendations were not based on new research; thus, a prospective assessment of the real impact of prophylaxis - known to be complex due to the need to include a large number of patients - will be welcome8. A primordial factor that was overvaluing, especially by the AHA, was the risk of anaphylaxis to amoxicillin over its possible prophylactic effect. In Brazil, we cannot ignore rheumatic fever - still the major etiology of valvular heart disease, with its peculiar structural and immunological characteristics -, nor the poor oral health of the general Brazilian population, which has not improved significantly over the past decades. Brazilian adults have recently shown a mean CPO-D (oral health index that translates the cavity experience of an individual over life) greater than 20 teeth, and a component of lost teeth (with no possibility of recovery) greater than 60%9. Therefore, it is not wise to ignore our epidemiological peculiarity of valvular heart diseases, tolerating interpretations of other cultures of a disease, whose bedside experience recommends thoughtfulness in preventing complications. That is why the Brazilian/Inter-American guidelines for valvular heart diseases, as published in 201110, recommends classic and expanded IEAP. The Brazilian Society of Cardiology and the Inter-American Society of Cardiology recommend antibiotic prophylaxis before starting dental interventional procedures that bear a high probability of significant bacteremia to patients who have either valvular or congenital heart diseases that represent a risk for IE, regardless of assumptions on differences of disease course. In addition, they reinforce the need for prospective and controlled studies to support the probability of the effect of IEAP. In conclusion, in face of the Brazilian reality and although we want to be globalized physicians with no cultural frontiers, it is difficult for us to comfortably rule out IEAP to a patient with native valvular lesion, endorsing the comprehensive recommendation of the Brazilian guidelines. That is despite the literature binomial of low incidence of IE and high probability of anaphylaxis to amoxicillin, the latter irrelevant in the Brazilian experience, and, thus, not even mentioned in our guidelines. Those with real bedside experience with IE patients will agree.

Infektiöse Endokarditis

Infective endocarditis is a serious disease that is often diagnosed with a considerable delay in clinical practice and therefore has a high mortality rate; therefore, early diagnosis and antibiotic treatment are extremely important. Epidemiological shifts in the age profile, new risk factors and the increasing use of intravascular prosthetic materials have led to changes in the microbial spectrum and clinical symptoms, which must be taken into account in the diagnostic efforts and therapy. Nonspecific symptoms and the increase in nosocomial endocarditis, especially in critically ill and immunocompromised patients require a high level of diagnostic expertise. With diagnostic algorithms based on guideline recommendations antibiotic treatment has to be initiated as early as possible. For patients with severe infective endocarditis a cardiac surgeon has to be involved from an early stage of the disease as in about 50 % of cases conservative antibiotic therapy alone does not alleviate the infection. Also early surgical treatment should be sought with the onset of complications. After effective treatment and patient survival there will always be an increased risk of suffering from renewed endocarditis. This is taken into account in the new recommendations of the European Society of Cardiology for the prevention of infective endocarditis.

Acute Aortic Valve Rupture from Infective Endocarditis after Transrectal Prostate Biopsy: A Call to Revise the AHA Guidelines for Prevention of Infective Endocarditis

We describe the case of a 63-year-old man with a known murmur who presented with a 4-month history of intermittent fever and a progressive reduction in energy level after a transrectal prostate biopsy (TRPB). He subsequently presented with acute heart failure secondary to aortic valve cusp rupture caused by endocarditis and underwent urgent aortic valve surgery. The 2008 American College of Cardiology/American Heart Association Guideline update on infective endocarditis has narrowed the use of antibiotic prophylaxis before most accepted dental procedures and continues to recommend against prophylaxis before genitourinary or gastrointestinal procedures. In contrast, the American Urological Association recommends the use of fluoroquinolones for the prevention of transrectal ultrasound–derived infectious complications. Notably, TRPB is associated with a high frequency of bacteremia and bacteriuria. In our case, an antibiotic course before the procedure and a more meticulous medical work-up after febrile illness might have mitigated the patient’s catastrophic medical presentation.

Assessment of Knowledge of Dental Staff at a Saudi Arabian University Regarding the Prophylaxis for Infective Endocarditis

The use of prophylactic antibiotics for the prevention of infective endocarditis following dental procedures has long been debated and there is still confusion regarding its efficacy. As a result, the prophylactic treatment varies considerably amongst different countries across the world and amongst different dental practitioners. Aim: To evaluate the knowledge of dental staff regarding the guidelines for the prevention of infective endocarditis.Methods: This was a cross sectional analytical study which included all staff members. A self administered questionnaire was used and responses were “graded” according to the American Heart Association (AHA) guidelines.Results: The response rate was 87% (N=39) and 97% reported to use the AHA guidelines; 66% reported their knowledge was based on previous training and scientific journals. Of those cardiac conditions and dental procedures which required prophylaxis; 47% and 65% chose the correct option, respectively. Penicillin was prescribed as the drug of choice by the majority of respondents. Conclusions: Although almost all staff reported the use of the AHA guidelines, many were not following them. The study emphasizes the need for continuous education and evaluation of this critical aspect of dentistry.

Prevention of Infective Endocarditis: Between Progress in Scientific Knowledge and the Lack of Randomized Trials

Prevention of Infective Endocarditis: Between Progress in Scientific Knowledge and the Lack of Randomized Trials

Management of the American Heart Association's guidelines for orthodontic treatment of patients at risk for infective endocarditis

For over 50 years, the American Heart Association has made recommendations for the prevention of infective endocarditis. The first guidelines were published in 1955; since then, they have been updated 9 times, most recently in 2007. There is still confusion about which orthodontic procedures are most prone to generate bacteremias and lead to infective endocarditis in susceptible patients. The aim of this study was to conduct a survey to determine orthodontists' knowledge, attitudes, and in-office behaviors regarding the American Heart Association's guidelines. A 4-page online survey consisting of 3 sections was sent to members of the American Association of Orthodontists by using a random number generator. The first section consisted of demographic information, the second consisted of questions about the respondents' practice characteristics, and the third included questions about the respondents' knowledge and management of the treatment of patients at risk for infective endocarditis. There were 78 responses. Orthodontists are screening for cardiac problems in the patient's medical history but to a lesser extent are requesting written medical clearance from the patient's physician before starting orthodontic treatment. Many of the orthodontists surveyed believed that their knowledge of the American Heart Association's guidelines and management of high-risk patients was in the good-to-excellent range. Orthodontists recommend antibiotic prophylaxis most frequently during band placement and removal. Patients at risk for infective endocarditis are somewhat likely to inquire about possible treatment sequelae associated with previous cardiac problems.

Infective endocarditis prevention prior to dental procedures

Infective endocarditis prevention prior to dental procedures

Prevention of infective endocarditis in developing countries

Infective endocarditis (IE) causes substantial morbidity and mortality despite modern antimicrobial chemotherapy and advances in the ability to diagnose and treat complications. Prevention of IE is, therefore, very important. Infective endocarditis usually develops following a bacteraemia in individuals with underlying structural cardiac defects. Bacteraemia may occur spontaneously, follow everyday procedures or complicate certain interventions, such as dental extraction.

Prevention of infective endocarditis in developing countries - justifiable caution?

The internationally accepted practice of prescribing prophylactic antibiotics to individuals at risk of infective endocarditis has come under scrutiny. There are no published high-quality randomised controlled trials of the intervention, but new insights have emerged. Bacteraemic episodes are common following simple activities such as brushing teeth. Endocarditis following procedures is extremely rare, and systematic reviews of the evidence for prophylactic antibiotics have failed to demonstrate efficacy.

Antibiotic Prophylaxis for Dental Procedures

The possibility that bacteremia from the mouth could cause infective endocarditis (IE) was first suggested >100 years ago, and it was later reinforced by others who targeted the viridans group streptococci from poor oral hygiene and dental extractions.1–3 These observations, along with the advent of antibiotics, eventually led to the first guidelines from the American Heart Association (AHA) in 1955. Antibiotic prophylaxis (AP) became the primary focus for prevention of IE and a standard of care for countries around the world. Controversy concerning efficacy and safety issues has existed for >30 years, and there has been a progressive reduction in the patient populations and the procedures suggested for AP since that time. Of concern, and in spite of a decreasing emphasis on AP for cardiac patients, upwards of 25 noncardiac patient populations are recommended for AP by some clinicians out of concern for systemic infections that might originate from dental procedures (eg, prosthetic joints).4 Article see p 60 Significant differences in recommendations from experts in the United States, United Kingdom, and other countries over the years highlight the lack of convincing data to either support or reject this practice. The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom issued new recommendations in 2006, which took the bold step of eliminating AP altogether.5 Current (2007) AHA guidelines narrow the focus to only 4 cardiac groups at higher risk for a bad outcome from IE but who represent ≈10% of all people at risk for IE.6 The AHA-defined moderate-risk groups represent ≈90% of people at risk for IE, all of whom were recommended for AP before 2007. There are, therefore, no …