Infective endocarditis: Updated guidelines

Canadian Paediatric Society, Infectious Diseases and Immunization Committee.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada (Impact Factor: 0.69). 06/2010; 21(2):74-7.
Source: PubMed


The most recent revision of the American Heart Association guidelines on infective endocarditis prophylaxis occurred in 2007. These revisions were based on the fact that current data have brought into question the benefit of previous recommendations for infective endocarditis prophylaxis. It was noted that the bacteremia that occurs following dental procedures represents only a fraction of the episodes of bacteremia that occur with activities of daily living (such as chewing, brushing teeth and other oral hygiene measures). The target groups and the procedures for which prophylaxis is reasonable have been significantly reduced in number. The focus is now on patients who are most likely to have adverse outcomes from infectious endocarditis. The present article is targeted at practicing Canadian physicians and provides the rationale for the current recommendations. In addition to a summary of the indications for prophylaxis, information is provided on the conditions for which prophylaxis is not recommended.

12 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Methicillin resistant Staphylococcus aureus (MRSA) septicemia is associated with high morbidity and mortality especially in patients with immunosuppression, diabetes, renal disease and endocarditis. There has been an increase in implantation of cardiac implantable electronic devices (CIED) with more cases of device-lead associated endocarditis been seen. A high index of suspicion is required to ensure patient outcomes are optimized. The excimer laser has been very efficient in helping to ensure successful lead extractions in patients with CIED infections. We present an unusual case report and literature review of MRSA septicemia from device-lead endocarditis and the importance of early recognition and prompt treatment.
    World Journal of Cardiology (WJC) 07/2012; 4(7):231-3. DOI:10.4330/wjc.v4.i7.231 · 2.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2 years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility. Materials and methods: A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. Results: Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%. Discussion and conclusion: The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level V; expert opinion.
    Orthopaedics & Traumatology Surgery & Research 11/2012; 98(8). DOI:10.1016/j.otsr.2012.07.013 · 1.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    The Open Dentistry Journal 07/2013; 7(1):82-7. DOI:10.2174/1874210601307010082
Show more


12 Reads
Available from