Risk Of Bacterial Endocarditis Research Articles

Caries Experience and Knowledge About Oral Health Importance Among Children with Congenital Heart Diseases in Kosovo

Objective: To determine the dental health of children with Congenital Heart Diseases (CHD) and to evaluate the parents’ knowledge of the importance of oral health and the risk of Bacterial Endocarditis. Material and Methods: This research included 140 children divided into the study group (80 children with CHD) and the control group (60 healthy children). The children were from different parts of Kosova, aged between 3-15. The parents were asked to complete a questionnaire containing demographic data (age and gender), general and special medical history (CHD types), knowledge about oral health importance and risk of bacterial endocarditis, and data about the daily oral hygiene child. The caries experience was reported using the DMFT/dmft index. Results: The average value of the dmft index was 6.7 for the study group and 5.62 for the control group, while the average value of DMFT index for the study group was 4.1, and for the control group was 3.47 (p>0.05). About 68.7% of parents of children with CHD were informed about their risk during dental interventions. However, knowledge was insufficient about the importance of oral health and dental prophylactic measures once only 32.7% of them were aware of those measures. Conclusion: No difference was observed between healthy and CHD children in caries experience and frequency of daily tooth brushing. Our findings provide evidence of a lack of knowledge about the importance of oral health and dental prophylactic measures among parents with CHD children.

ORAL AND DENTAL MANAGEMENT IN CHILDREN WITH TETRALOGY OF FALLOT : A LITERATURE REVIEW

Background: Congenital heart disease is a condition of heart anomaly and or disfunction of heart since birth. The most common congenital heart disease is Tetralogy Of Fallot (TOF). The disorder has four features, a ventricular septal defect, aortic overriding, stenosis pulmonary, and hypertrophy right ventricular. Method: This review aimed to talk about oral manifestations and discuss options of several oral and dental management in children with TOF. Result: Oral and dental treatment of pediatric patient with cardiovascular disease is important to be carried out with the risk of bacterial endocarditis. Conclusion: Oral and dental management in a child with congenital heart disease is very important. Main point of dental management are dental health education, preventive dental treatment and control periodic after dental treatment.

Antibiotic Prescribing for Endodontic Infections and Prophylaxis for Medically Compromised Patients: A Survey on Dental Students in Turkey

Introduction: High and wrong antibiotic usage causes Antimicrobial Resistance (AMR) which is a worldwide problem. Dental students, as future dentists are likely to provoke this public health issue by inappropriate prescribing choices. There is a need of further education of antibiotic prescription in endodontic infections, as well as prophylaxis. Aim: The aim of this study was to establish the knowledge of dental students on the suitable use of systemic antibiotics for endodontic infections and prophylaxis for medically compromised patients. Materials and Methods: A survey was done on dental students at the end of third, fourth and fifth years, who answered a questionnaire about antibiotic use for endodontic infections and prophylaxis for various immunocompromised patients. Pharmacology and endodontics lectures should be taken by respondents; was the inclusion criterion. Data were analysed using descriptive statistics and Chi-square test. Statistical significance was fixed at p<0.05. Results: Amoxicillin + clavulanic acid (500/125 mg) was the first-choice antibiotic of students. The percentage of fifth grade students who would prescribe amoxicillin + clavulanic acid (500 mg/125 mg) was lower than third and fourth grade students (p=0.006). In case of allergy to penicillin, clindamycin 300 mg was selected as a first-choice antibiotic by 78.3% of students. About 50.2% of the respondents indicated a treatment duration of 3-7 days, while 28.5% chose more than seven days usage. Fourth grade dental students who would prescribe antibiotics for more than seven days (40.7%) were found to be statistically more significant than third (27.8%) and fifth (16%) grade students (p=0.004). In case of acute apical abscess with systemic manifestations, 94.5%, which is the highest percentage of all, of students would prescribe antibiotic. Third grade dental students were the most antibiotic prescribing group for chronic apical periodontitis and periradicular (pocket) cyst (p=<0.001). Patients with history or risk of bacterial endocarditis, were prescribed prophylactive antibiotics at a rate of 92.3% by students. Conclusion: Even though the results showed acceptable levels of competence, dental education should place greater focus on prescription of antibiotics to prevent Antimicrobial Resistance (AMR).

Toxicity of agents used for opioid withdrawal: a case-based approach.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Bacteraemia Following Different Orthodontic Treatment Procedures

The purpose of this research was to estimate the percentage and nature of bacteraemia following four orthodontic treatment procedures which were: an upper alginate impression, separator placement, band fitting or placement, and arch wire adjustment on a fixed appliance. The study group consisted of 40 patients (25 females and 15 males) ranging from 17-25 years of age attending Orthodontic Department in the College of Dentistry/Baghdad University, and out patients department from private clinic. The 40 patients were divided into four groups (10 patients each). A cannula was inserted into either the left or right antecubital fossa using an aseptic technique. A 5ml of blood was taken immediately before orthodontic treatment procedure and a second 5ml sample was taken 1-2 minutes after the procedure.The blood samples showed a percentage of bacteraemia of 50%, 40%, 30%, and 20% in cases of post-band placement, post-separator placement, post-arch wire adjustment, and post-alginate impression procedures respectively.This investigation demonstrated that the placement of separator and fitting of band procedures could cause a significant bacteraemia, thus these procedures for patients at–risk of bacterial endocarditis should be placed in consideration, and the orthodontist should be advised to consult the patient's medical specialist for controlling and prescribing the necessarily antibiotic coverage.

The Risk of Bacterial Endocarditis after Percutaneous and Surgical Biological Pulmonary Valve Implantation

Objective: Biological pulmonary valves tend to degenerate and develop stenosis and/or incompetence that limits long-term survival of the valves. In addition there is a risk for bacterial endocarditis. We analyzed and compared the outcome of surgically and interventionally implanted pulmonary valves over a 5-year period.

The risk for bacterial endocarditis in cirrhotic patients: a population-based 3-year follow-up study

We noted only rare reports of cirrhotic patients with bacterial endocarditis (BE). There is insufficient data on the risk of BE in liver cirrhosis. This is the first national population-based study evaluating the risk of BE in cirrhotic patients. We used the National Health Insurance Database, which is derived from the Taiwan National Health Insurance Program. The study cohort comprised 40803 patients with cirrhosis and the comparison cohort consisted of 40841 randomly selected subjects with a similar age and sex distribution. Of the total 81644 patients, 192 (0.24%) experienced BE during the 3-year follow-up period, 121 patients from the study cohort (0.30% of the cirrhotic patients) and 71 patients from the comparison group (0.17% of non-cirrhotic patients) (p<0.001). After adjusting for patient age, sex, and comorbid disorders, the Cox regression analysis showed that cirrhotic patients had a high risk of BE compared to non-cirrhotic patients during the 3-year follow-up period (hazard ratio 2.04, 95% confidence interval 1.61-2.44, p<0.001). We conclude that liver cirrhosis is a risk factor for the occurrence of BE.

Physician compliance with American Heart Association guidelines for prevention of bacterial endocarditis in dental procedures

To evaluate physicians' compliance level with the American Heart Association (AHA) 2007 guidelines concerning the management of dental patients at risk for bacterial endocarditis. Materials and methods: This study included 103 patients with cardiac problems. The mean age was 41.02 ± 15.22 years. According to consultations with physicians, the selection of the antibiotic, the timing, and the dosage were recorded on patients' forms prior to dental procedures by the researchers of the Department of Oral and Maxillofacial Surgery and Department of Oral Diagnosis and Radiology. Physicians' compliance level with the AHA 2007 recommendations was evaluated. Results: Antibiotic prophylaxis was prescribed for 75 (72.8%) of 103 patients with cardiac problems although it was not indicated. On the other hand, antibiotic prophylaxis was recommended with correct indication for 22 patients (21.3%). Two (9.1%) of these 22 patients were prescribed appropriate antibiotics, with correct dosage and timing by the physicians according to the AHA 2007 guidelines. Amoxicillin (20.0%) and combinations of the antibiotics (20.0%) were the first choices for prophylaxis. No antibiotic regimen was prescribed for 6 patients (5.9%), who did not require antibiotic prophylaxis according to the AHA 2007 guidelines. Conclusion: Clinicians are not always aware of the current clinical guidelines regarding antibiotic prophylaxis and must be aware of the contemporary guidelines and avoid prescribing excessive antibiotics to prevent emergence of resistant organisms.

Endokarditisprophylaxe: Was hat sich geändert?

The American Heart Association (AHA) radically changed the recommendations regarding endocarditis prophylaxis, if patients undergo dental work. For the vast majority of patients previously considered to be at significant risk for bacterial endocarditis (especially patients with degenerative and rheumatic heart disease), routine endocarditis prophylaxis is not longer recommended from a cost-benefit-risk standpoint. Only patient populations with a very high lifetime risk for bacterial endocarditis or an expected worse outcome (patients with prosthetic heart valves, conservatively treated endocarditis, and certain groups with congenital heart disease) are judged candidates for endocarditis prophylaxis. In 2007, a German position paper (S2 guideline) comments the AHA recommendations. This position paper allows a more individual approach, if treating physician and patient agree upon the benefit of endocarditis prophylaxis in the individual case.

Cardiovascular Considerations in Patients Undergoing Gastrointestinal Endoscopy

Gastrointestinal endoscopies are common procedures for diagnosis and treatment. Patients with various cardiovascular conditions can undergo these procedures, including those patients with acute myocardial infarction, but appropriate precautions need to be maintained, especially with procedure-induced autonomic nervous system pertubations that can affect heart rate and blood pressure. In this article, treatment recommendations are included for those patients undergoing endoscopy who are receiving anticoagulation and for those who are at risk for bacterial endocarditis.

Low frequency of bacteraemia during eye surgery obviates the need for endocarditis prophylaxis.

To determine the incidence of bacteraemia following eye surgery, and thereby evaluate the need for antibiotic cover during such procedures, in patients who are at risk for bacterial endocarditis. This prospective study involved 50 consecutive patients undergoing extraocular surgery at the Sultan Qaboos University Hospital, Muscat, Oman. Local preparation of the surgical site in all patients included pre-operative instillation of 0.3% gentamicin and 3% povidone-iodine eye drops. Two eye swabs (one from the conjunctival sac and another from the eyelid margin) and two venous blood samples (one taken just before the procedure and the second 10 min into it) were collected and cultured for aerobic and anaerobic bacteria. Surgery-related bacteraemia was defined as a negative pre-operative blood culture followed by a positive intraoperative blood culture of the same bacterium identified in the positive eye swab. Only two patients (4%) demonstrated surgery-related bacteraemia: one caused by Staphylococcus epidermidis (following entropion correction) and the other by Haemophilus influenzae (following dacryocystorhinostomy). Four other patients had positive conjunctival swabs without bacteraemia, the causative organisms being Haemophilus influenzae in two, and Staphyloccus aureus and Klebsiella pneumoniae in one each. Ophthalmic surgery is not associated with significant bacteraemia, and therefore does not mandate routine antibiotic cover in patients at risk for bacterial endocarditis. Stringent pre-operative preparation of the surgical site may suffice to minimise bacteraemia; however, this requires further study.

Current medical management of valvular heart disease.

Drug therapy plays a key role in the management of valvular heart disease, though in many cases it does not alter its course or delay the need for surgery. The importance of drug therapy lies in stabilizing the patient's condition when the disease is due to abnormal valve structure, and in treating the underlying condition when the condition is due to a functional abnormality. Drug therapy also lowers the risk of bacterial endocarditis and rheumatic fever.

The Pharmacology of Substance Abuse and Its Effects on Therapy

Summary Delirium tremens may occur upon acute withdrawal and may be fatal. The alcoholic patient admitted for maxillofacial trauma should be managed for acute ethanol withdrawal. Liver damage may be significant and coagulation may be affected. Patients also may be more prone to infections, and surgical wound healing may be slow. Chronic abusers of ethanol require larger doses of many anesthetic drugs. Acute intoxication is additive with anesthetic agents, reducing anesthesia requirements. Chronic abusers of heroin and other opioids have low tolerance to pain, require increased doses of opioids, and may acutely withdraw with opioid antagonists. Postoperative pain control may be problematic and chronic abusers often complain that pain medications do not work. The possibility of transmitting blood-borne infections are high, especially hepatitis B and C and HIV. Liver damage from hepatitis also may be present and coagulation problems may develop. Heart valve damage can occur and the risk of bacterial endocarditis may be significant. Wound healing also may be delayed. Because these patients get frequent skin and dental infections, they may develop resistant strains of organisms to several of the most widely used antibiotics. Chronic abusers of cocaine have paranoid delusions, labile blood pressure with extreme hypertension, and difficult vascular access. Acute toxicity causes seizures, ventricular fibrillation, and sudden death. Marijuana users frequently use ethanol and may be subjected to the same risks as alcoholics. Long-term abusers of marijuana have chronic bronchitis and a sensitive airway. In light brevital anesthesia, laryngospasm may be a problem. Acute toxicity is associated with tachycardia, hypotension, injected sclera, and somnolence. The psychotomimetic effects of PCP are long lasting. Bizarre violent behavior occurs, including apparently painless self-mutilation. Hallucinations are common. Acute intoxication resembles ketamine anesthesia with open-eyed stare, active laryngeal reflexes, hypertension, and tachycardia. Patients need special treatment for extended periods until they are drug free. These patients may exhibit unexpected behavioral patterns during office anesthesia.

A brief review of indigenous Australian health as it impacts on oral health.

The indigenous population of Australia constitutes approximately 2 per cent of the total population. This group has faced significant cultural, economic and health changes since European settlement some 200 years ago. In this brief review some of the health changes that have influenced the oral health status of this community have been examined. Of major importance is the dietary change that the once nomadic indigenous community has undergone. Today's Western diet, high in sugar, low in proteins and vitamins, has resulted in a significant increase in the risk (and prevalence) of caries and periodontal disease. In addition, the high prevalence of diabetes also exacerbates the periodontal problem. The remoteness of a significant proportion of Australian indigenous communities from modern health care services and limited access to fluoridation increases the incidence of oral disease. It is also noted that the incidence of rheumatic heart disease is one of the highest in the world, thereby increasing the risk of bacterial endocarditis. It is clear that indigenous communities have unique oral health needs but the extent of these needs is not well documented. It is important that more research be undertaken to assess these needs so that appropriate oral health programmes can be developed.

DRESSING THE PART

Wound care after cutaneous surgery can play an integral role in wound healing. Wound care regimens have changed dramatically over the last 35 years as the physiology of wound healing has become better understood. Foremost is the improvement in wound healing achieved by keeping the wound occluded and moist. This observation has led to an explosion of a whole new category of occlusive dressings at the surgeon's disposal in healing postoperative wounds. These dressings have numerous applications as discussed previously. Generally, for acute surgical wounds, occlusive dressings are most useful for split-thickness wounds, such as graft donor sites and after dermabrasion, chemical peel, or laser treatment, and full-thickness wounds allowed to heal by secondary intention. Occlusive dressings may have greater benefit for the treatment of chronic ulcers of varying etiologies. The different categories of dressings share the common disadvantage of being relatively expensive. For routine sutured wounds, the authors prefer the readily available and inexpensive Telfa-type dressing combined with a topical antibiotic ointment. Topical antiseptics are useful for reducing bacterial counts on intact skin in preparation for surgery. Povidone-iodine (Betadine) and chlorhexidine gluconate (Hibiclens) have emerged as the two agents of choice. However, antiseptics have been shown to be toxic to healing tissue, and should not be used on open wounds. In contrast, topical antibiotic ointments are safe to use on open wounds, effective in preventing wound infections, and promote wound healing by maintaining a moist wound environment. The authors prefer the combination antibiotic ointment Polysporin for routine postoperative wound care. Antibiotic prophylaxis in dermatologic surgery to prevent wound infection is appropriate in certain cases. Surgery performed on grossly contaminated or infected skin requires a full 7 to 10 day course of antibiotics. Procedures in anatomic areas considered contaminated as well as in clean areas with significant environmental or patient risk factors may benefit from antibiotic prophylaxis. The choice of antibiotics should be based on the organism most likely to cause wound infection at the particular surgical site. Evidence supports giving a single preoperative dose 1 hour before surgery with a second dose possible 6 hours later if the procedure is prolonged or delayed. The risk of bacterial endocarditis after dermatologic surgery is not known. Antibiotics are indicated for any procedure on obviously infected skin, but are not routinely required for very minor procedures, such as small biopsies, on intact skin. Antibiotic prophylaxis may be prudent for those patients classified as high risk by the (AHA). The antibiotic chosen should again cover the organism most likely to cause infection. One dose can be given 1 hour before surgery and repeated 6 hours postoperatively. Finally, wound healing can be greatly impacted by what the patient does or does not do after leaving the office. Therefore, wound care instructions should be clear, detailed, and provided in both oral and written form. Information should also be provided about what to expect as the wound heals.

TOP STORIES OF 1997.

The Top Medical Stories of 1997 Each year, the Editors of Journal Watch choose the past year's top medical stories. Typically, stories emerge from a group of papers on a similar topic, rather than a single study. All citations are from 1997 unless otherwise stated. --AS Brett. A TURBULENT YEAR FOR DIET PILLS 1997 was a turbulent year for diet pills, beginning with carryover from the late-1996 concerns about the association of dexfenfluramine (dexfenfluramine) use and primary pulmonary hypertension ( JW Accession Number 960913001, or N Engl J Med 1996 Aug 29:335;609; also JW Accession Number 961115005). By mid-1997, dexfenfluramine and the combination of fenfluramine and phentermine, known as fen-phen, were in still bigger trouble. A case series and several additional cases reported in the New England Journal of Medicine ( JW Accession Number 970718001, or N Engl J Med Aug 28; 337:581; also JW Accession Number 970905001, or N Engl J Med Aug 28: 337;602, 629, 635, 636) found significant mitral, aortic, or tricuspid valve disease in 53 patients who had been taking fen-phen for an average of 10 months. By September, the FDA had received a total of 144 case reports of valvular disease associated with fen-phen or dexfenfluramine, of which 77 percent were symptomatic. The FDA also reported that 33 percent of 284 asymptomatic fen-phen and dexfenfluramine users had abnormal cardiac valves on echocardiography. Accordingly, the makers of dexfenfluramine and fenfluramine pulled them from the market, and the U.S. Department of Health and Human Services recommended that all dexfenfluramine or fen-phen users have a cardiac evaluation, with echocardiography for patients with positive physical findings or at risk for bacterial endocarditis ( MMWR Nov 14; 46:1061). In late November, the FDA did approve another serotonergic agent, sibutramine, after having rejected it in 1996 because of an association with risk for hypertension, …

Bacteremia shortly after placental separation during cesarean delivery

To assess frequency, risk factors, and microbiology of bacteremia within 15 minutes of placental separation during cesarean delivery. Ninety-three women undergoing cesarean delivery after a minimum of 4 hours of labor or ruptured membranes were compared with 26 women not in labor undergoing cesarean. Blood cultures for aerobic and anaerobic bacteria were obtained within 15 minutes of delivery of the placenta and before prophylactic antibiotic administration. Chorioamnionic membranes were also cultured. Demographic, labor, delivery, and postpartum characteristics were abstracted from the medical record. Bacteremia was detected in 13 (11%) of 119 women. Bacteremia occurred in 13 (14%) of 93 women after labor or rupture of membranes compared with zero of 26 women not in labor (P = .02). Isolates included group B streptococcus (n = 5), Gardnerella vaginalis (n = 5), Streptococcus pneumoniae (n = 1), Peptostreptococcus sp (n = 1), and mixed flora of Prevotella bivia, G vaginalis, and viridans streptococci (n = 1). Bacteremia was associated with earlier median gestational age, lower median birth weight, and a positive chorioamnionic membrane culture. After adjustment for gestational age, intrauterine monitoring was also significantly associated with bacteremia. Bacteremia was common after labor in this population, especially in preterm deliveries and those with positive chorioamnionic-placental culture. Many of the isolates are capable of causing endocarditis. Appraisal of the risk of bacteremia and the risk of bacterial endocarditis should be made in individual patients to assess the need for antibiotic prophylaxis.

Antibiotic prophylaxis in patients undergoing radiological procedures who are at risk of infective endocarditis — Do radiologists know what they are doing?

The British Society for Antimicrobial Chemotherapy has published guidelines recommending that all patients with prosthetic heart valves, or those with a previous history of bacterial endocarditis, should receive prophylactic antibiotics before procedures likely to cause a bacteraemia, due to the potential risk of bacterial endocarditis. The guidelines are widely available, notably in the British National Formulary. Two separate and independent surveys of radiologists in this Region showed that there was poor awareness of these guidelines and their implications for radiology departments.

PREVENTING POST-TREATMENT BACTEREMIA: COMPARING TOPICAL POVIDONE-IODINE AND CHLORHEXIDINE

It is well known that the occurrence of bacteremia after dental procedures can place certain patients at risk for bacterial endocarditis. The authors compared the efficacy of two antiseptic agents in the prevention of post-treatment bacteremia in 120 dental patients. Before treatment, dentists irrigated the gingival sulcus of each patient with 10 percent povidone-iodine, 0.2 percent chlorhexidine or sterile water. The authors report lower levels of bacteremia among patients treated with the povidone-iodine solution.

‘Usual and customary’ practice versus the recommendations of experts: clinician noncompliance in the prevention of bacterial endocarditis

Data were collected from a representative sample of American general practitioners to ascertain adherence to the recommendations by the American Heart Association (AHA) concerning management of patients at risk for bacterial endocarditis. Inconsistencies were found in the prescribing of appropriate risk-related therapies such as proper timing, selection of antibiotics, and associated dosages. It is suggested that clinicians' compliance level with these recommendations may be raised by a careful reading of the AHA's latest findings.