Infective Endocarditis Prophylaxis Research Articles

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.

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.

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.

Abstract 16204: Scaling Hearts: Exploring the Link Between Psoriasis and Infective Endocarditis in Pacemaker Patients

Introduction: Device related infective endocarditis (IE) is associated with high morbidity and mortality resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis, a chronic inflammatory skin disorder with multifactorial etiology, is increasingly being identified as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemaker (PPM). Hypothesis: Psoriasis patients with PPM have an increased risk of developing IE. Methods: Patients with a history of PPM implantation were sampled from the National Inpatient Sample Database (2016 - 2018). Comorbidities were identified using ICD-10 codes. Individuals with age < 18, history of endocarditis, immunosuppression, central line associated infections, intravenous drug use, and implantable cardiac defibrillators were excluded. Patients were stratified into two groups based on the presence of psoriasis. A univariate analysis followed by a multivariate analysis adjusting for age, gender valvular disease, dental infections, coronary artery disease, and sixteen other comorbidities was performed. Furthermore, 1:10000 propensity score matching was performed between the psoriasis and non-psoriasis groups and rates of IE were calculated. Results: Out of the 437,728 patients included in the study, 45 (4.4%) had psoriasis. Psoriasis patients were older and had more coronary artery disease. Psoriasis patients had significantly higher rates of endocarditis (4.4% vs 0.6%; p<0.001). On multivariate analysis, psoriasis was linked to a 7.2-fold higher IE risk compared to patients without psoriasis (OR: 7.2 [1.7-30.2]; p=0.007). Post-match analysis showed similar results with 8.3-fold higher rates of IE in psoriasis patients (OR: 8.3 [2.0-34.4]; p<0.001). Conclusions: Psoriasis was independently associated with elevated risk of IE in patients with PPM. The chronic inflammatory state associated with psoriasis likely contributed to this risk. Further large-scale studies are required to corroborate these findings as this will have implications on consideration of IE prophylaxis for these patients.

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.
 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.
 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.
 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

Acute neurological symptoms as a debut of infective endocarditis

Infective endocarditis (IE) is an infl ammatory disease of the endocardium of the heart affecting heart valves (native or prosthetic) and, in the last few decades, also available intracardiac permanent devices or catheters. Despite technological progress and accumulated experience, this disease continues to be a huge challenge for doctors in terms of diagnosis, treatment and improvement of survival. The clinical picture is atypical and heterogeneous, with different clinical "masks" of other diseases – infectious, oncological, hematological, rheumatological, neurological, etc. Embolic complications are often the fi rst manifestation of the disease and are most often cerebral. We present a clinical case of a 29-year-old woman with acute neurological symptoms as a fi rst manifestation of IE. This case refl ects the atypical clinical presentation of the disease, the importance of new imaging modalities for the precise diagnosis of neurological complications, and the decision on the timing of operative intervention when indicated. The question of IE prophylaxis in moderate-risk patients, such as those with mitral valve prolapse and bicuspid aortic valve, remains open.

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.

Antibiotic Prophylaxis for Infective Endocarditis: A Survey of Practice Among Pediatric Cardiology Providers.

The 2007 American Heart Association (AHA) guidelines limited antibiotic prophylaxis (AP) for infective endocarditis (IE) to fewer patients with predisposing cardiac conditions (PCC). We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery (AAP SOCCS) on their recommendations for AP for a number of PCC and procedures. We report on those 173 respondents who follow the 2007 AHA guidelines. AP rates for high-risk PCCs clearly meeting AHA criteria ranged from 70.5-89.8%. Conversely, for PCCs which did not meet AHA criteria, prescribing rates varied from <1% to 29.5%. PCC for which AP indication was unclear per guidelines, AP rates similarly varied from 9.9-39.8%. Similar variability is noted in AP for various procedures in setting of high-risk PCC. There is variability in AP prescribing practices among pediatric cardiologists based on both underlying PCC and noncardiac procedures in the setting of underlying cardiac disease.

Infective Endocarditis

Infective endocarditis preoccupies a substantial place in infectious emergencies, and treatment delays are likely to cause increased mortality and morbidity. This paper attempts to explore and discuss the current knowledge on the diagnosis, treatment, and prophylaxis of infective endocarditis in light of the relevant literature. Infective endocarditis is an infectious condition that still keeps its significance and

Evaluation of Change in Knowledge, Attitude and Adoption Regarding Antibiotic Prophylaxis for Infective Endocarditis Before and After Health Education among Dental Interns in a Private Dental Teaching Institution in India

Background: There was paucity of data regarding updating of 2007 AHA (American Heart Association) guidelines among dentists in India.
 Objective: To evaluate change in knowledge, attitude and adoption of AHA (2007) guidelines regarding Antibiotic prophylaxis for Infective endocarditis before and after health education among dental interns in a private dental teaching institution.
 Materials and Methods: This was an interventional study conducted among dental interns in a teaching dental institution. Data was obtained using a validated questionnaire that finally had 32 items. Data was obtained by sharing an online link to complete survey. A reminder was also given one week later and participant responses obtained. Each correct response for a question was assigned a score of 1 while incorrect response was scored as zero. Total score was computed for each participant. Health education on AHA 2007 guidelines for antibiotic prophylaxis against infective endocarditis was offered to participants using power point presentation for about 30 -45 minutes on a scheduled day following baseline data collection. Immediately after health education, participants were again requested to fill the same questionnaire used at baseline. Mean knowledge score before and after health education was compared using paired sample t-test.
 Results: 74 participants were considered with response rate of 91.4%. Mean knowledge score significantly increased from 11.5 ± 4.3 (Mean ± Standard deviation) at baseline to 22.9 ± 4.2 post intervention (p < 0.001).
 Conclusion: Health education intervention was successful in improving knowledge, attitude and adoption of AHA 2007 guidelines for antibiotic prophylaxis against IE among dental interns.

Anaesthetic management for a patient with Eisenmengers syndrome undergoing ovarian cystectomy

Eisenmenger's syndrome is a cyanotic congenital heart disease, where septal defects or patent ductus arteriosus advances to pulmonary hypertension with reversed/ bidirectional shunt. Any condition that lowers systemic vascular resistance, increases the degree of right to left shunt and the risk for the patient. Case Presentation: We report anaesthetic management of a 25-year-old P2L2 Female weighing 50kg with Eisenmenger's syndrome presented with an 8.3cm×7.5cm×8.4cm right ovarian cyst posted for ovarian cystectomy. The procedure was done under epidural anaesthesia, & post-operatively epidural analgesia was administered for 48 hours. After removal of epidural catheter, multimodal analgesia and anticoagulant therapy with Low Molecular Weight Heparin (LMWH)5000 IU by subcutaneous route was initiated. The mainstay of anaesthetic management in Eisenmenger's syndrome revolves around providing analgesia without decreasing systemic vascular resistance, or increasing pulmonary vascular resistance. Other concerns are hypercoagulable state, global hypoxia, Volume overload, hypercarbia, acidosis, hypovolemia. Systemic hypotension and increased pulmonary resistance associated with General Anaesthesia, & marked sympathectomy associated with spinal anaesthesia make both these modes of anaesthesia relatively risky compared to the plain epidural. Other concerns addressed during perioperative management were Oxygen support, early thromboprophylaxis, infective endocarditis prophylaxis, fluid restriction, and correction of acidosis.

Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

Objectives: To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus (PDA) in children. Background: National antibiotic prophylaxis (AP) guideline for infective endocarditis changed after 2009, the effect on practice of PDA closure is unknown. Methods: Observational single center study analyzing follow-up of PDA closure comparing two time periods before (2002–2009) and after (2010–2019) changes in AP guideline. Results: 332 patients (68.1% female), median (interquartile range) age 3.0 years (1.5–5.7) and body weight 14.0 kg (10.0–19.3), were enrolled. PDA morphology was conical type A (50.3%), window type B (1.2%), tubular type C (40.1%), complex type D (2.1%), elongated type E (0.9%) and other (5.4%). Minimal PDA diameter and length were 1.9 mm (1.3–2.5) and 8.0 mm (6.2–10.2). PDA was closed using coils (56.3%), Amplatzer Duct Occluders (41.9%) and others (1.8%). Complete closure rate was 61.1% at catheter intervention, 72.3% on day 1, 87.7% after 6 months and 98.4% at last follow-up on echocardiography. Moderate complication rate (severity level 3) was 4.2% and major complication rate (severity level 4) 0.3%, with no catastrophic complications (severity level 5). Annual PDA closure rate declined in the second time period (22.6/year vs. 15.5/ year, p = 0.018), PDA size increased (1.6 mm vs. 2.0 mm, p = 0.002) and proportion of coils decreased (72.4% vs. 37.1%, p < 0.001). Conclusions: Interventional closure of PDA is associated with excellent closure rates during follow-up (>98%) and only a small number of complications leading to reintervention or surgery. Change in AP guidelines changed indication for and practice of PDA closure.

Infective Endocarditis in Patients with Hypertrophic Cardiomyopathy

A literature review is presented, reflecting the incidence, etiology, hemodynamics, localization, clinical manifestations, outcomes and treatment of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM). Despite the relative rarity of IE in patients with HCM, the combination of these pathologies is characterized by mutual aggravation and poor prognosis. The addition of IE increases the risk of death in patients with obstructive HCM, deteriorating circulatory disorders, increasing the likelihood of uncontrolled sepsis and embolism. Conservative treatment of IE in patients with HCM does not differ from that without HCM. Interdisciplinary interaction is needed in the management of patients with IE against the background of HCM in determining the indications for cardiac surgery and choosing the optimal method. Antibacterial prophylaxis of IE before invasive medical manipulations in patients with HCM is not recommended by the current consensus documents, however, the decision for each patient should be made individually, with a mandatory assessment of the risk of IE, the severity of hemodynamic disorders and prognosis.

Streptococcus oralis MitraClip endocarditis following a dental procedure: a case report

BackgroundTranscatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism.Case presentationAn 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later.ConclusionsDespite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward.

English

BACKGROUND Infective endocarditis [IE] prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. The study intended to compare the antimicrobial potency of amoxicillin, cephalexin, and clindamycin against Streptococcus mutans, the common causative organism of dental infections. The objective was to assess the potency of recommended choice of antibiotics and its efficacy among each other in infective endocarditis prophylaxis during dental procedures. METHODS Saliva samples [N = 20] were collected from patients susceptible for IE and Streptococcus mutans was cultured in Infusion Agar. The principle used in this study was based on the Kirby - Bauer disc diffusion Antimicrobial Susceptibility Test [AST] Method and minimum inhibitory concentration [MIC]. In this method, the three HiMedia antibiotic discs of amoxicillin, cephalexin and clindamycin were loaded and assessed for measurable “zone of inhibition” against mutans. RESULTS One-way ANOVA was used to compare the means of zone of inhibition of each disc. The test was statistically significant with F value of 4.093 at P value 0.038. Post hoc analysis was conducted using Tukey’s HSD test as one-way ANOVA was statistically significant. The mean difference of 13.16 mm between amoxicillin and cephalexin was found to be statistically significant at P value 0.041 with lower and upper bound at 0.527 and 25.806 respectively. The mean difference of 2.65 mm between amoxicillin and clindamycin and - 10.50 mm between cephalexin and clindamycin was not found to be statistically significant. CONCLUSIONS Amoxicillin showed to be more potent among the antibiotics chosen for this study. Clindamycin showed to be a better alternative to cephalexin and could be the first choice in case of patients allergic to penicillin group of drugs. KEY WORDS Antibiotic Prophylaxis, Infective Endocarditis, Antimicrobial Potency, Minimum Inhibitory Concentration [MIC], Antimicrobial Susceptibility Test [AST], Kirby Bauer Disk Diffusion Method

Evaluation of Dentists’ Knowledge in Infective Endocarditis Prophylaxis

Infective endocarditis (IE) is an infection caused by microorganisms affecting the natural/prosthetic heart valve and surrounding tissues. Antibiotic prophylaxis is necessary to prevent IE in some dental procedures due to mortality rate. This particular study was primarily motivated to evaluate the dentists’ knowledge in IE prophylaxis. Participants of the study were 80 dentists who were selected through the purposive sampling method (Female= 44; Male= 36). To collect data, a questionnaire with questions about prophylaxis data on heart diseases, dental procedures, the purpose, frequency, duration and dose of the drugs used was used. The participants were informed about prophylaxis of IE after the data collection during a seminar. Subsequently, their responses to the questionnaire items were statistically analyzed and the relevant results were presented in the following section. 36 male and 44 female dentists working in Kahramanmaras city center and districts participated in the study on a voluntary basis. It was revealed that the respondents tend to decide on IE prophylaxis mostly requesting consultation from cardiologists (68.8%), family physicians (2.6%) and infectious diseases specialists (1.3%) while 3.9% of them applied prescription only based on their professional experience. This particular research has shown that dentists made some mistakes while performing antibiotic prophylaxis such as unnecessary use of antibiotics. Based on this finding, they should be provided in-service training programmes organized on a regular basis to contribute to their professional development by updating their field knowledge.

Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association.

In 2007, the American Heart Association published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent viridans group streptococcal (VGS) infective endocarditis (IE) in cardiac patients undergoing invasive procedures. The 2007 guidelines significantly scaled back the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories thought to confer the highest risk of adverse outcome. The purpose of this update is to examine interval evidence of the acceptance and impact of the 2007 recommendations on VGS IE and, if needed, to make revisions based on this evidence. A writing group was formed consisting of experts in prevention and treatment of infective endocarditis including members of the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, in addition to the American Heart Association. MEDLINE database searches were done for English language articles on compliance with the recommendations in the 2007 guidelines and the frequency of and morbidity or mortality from VGS IE after publication of the 2007 guidelines. Overall, there was good general awareness of the 2007 guidelines but variable compliance with recommendations. There was no convincing evidence that VGS IE frequency, morbidity, or mortality has increased since 2007. On the basis of a review of the available evidence, there are no recommended changes to the 2007 VGS IE prevention guidelines. We continue to recommend VGS IE prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all. Randomized controlled studies to determine whether antibiotic prophylaxis is effective against VGS IE are needed to further refine recommendations.

Practical aspects of infective endocarditis prevention

The review is devoted to the practical aspects of infective endocarditis (IE) prevention, the issues of which, as before, remain the subject of lengthy discussions. Despite repeatedly updated national and international guidelines on this topic, medical practitioners are not always fully aware of antibiotic prophylaxis of IE. After a brief consideration of the etiological, pathogenetic features and risk factors of the disease, the main provisions of 2015 European Society of Cardiology guidelines on IE prevention, which were approved by the Russian Society of Cardiology, are presented. The categories of patients with the highest risk of IE, procedures associated with an increased risk of IE (dental and other invasive procedures) are described in detail. The main practical approaches to the identification of risk groups and performing invasive procedures that influence the decision to prescribe antibiotic prophylaxis are described. Particular attention is paid to the characteristics of both first-line antibiotic drugs and alternative agents for penicillin allergy or in cases of β-lactamase secreting pathogens.