ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Endorsed by the Society of Cardiovascular Anesthesiologists

Journal of the American College of Cardiology (Impact Factor: 16.5). 09/2008; 52(8):676-85. DOI: 10.1016/j.jacc.2008.05.008
Source: PubMed
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Available from: David P Faxon
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    • "The 2011 American Urological Association’s best practice policy statement recommends the use of prophylactic antibiotics in all patients (declaring fluoroquinolones the most suitable antibiotic for prophylaxis) before TRPB for the prevention of all infectious complications (class Ib recommendation). 8 However, many groups, including the AHA, do not recommend prophylactic antibiotic use solely for the prevention of endocarditis related to GU or GI procedures.2 This may be because of the lack of reports linking endocarditis to these procedures. "
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    ABSTRACT: 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.
    Full-text · Article · Feb 2013 · Clinical Medicine Insights: Case Reports
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    • "One of the most important pathogeneses of coronary artery stenosis and VHD is inflammatory response of immune system. Prevalence and incidence of cardiovascular diseases resulting from rheumatologic disorders are increasing , however, advanced treatments which are now available [1] [2] [3]. Rheumatic diseases can be assumed by taking a clinical history and conducting thorough physical examination. "
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    ABSTRACT: Background and Objectives. Valvular heart diseases are among the frequent causes of cardiac surgery. Some patients have a well-known rheumatic condition. Heart valves are fragile connective tissues which are vulnerable to any systemic autoimmune diseases. This study was designed to evaluate the frequency of rheumatological background in patients candidate for valvular heart surgery in Afshar Cardiovascular Center, Yazd, Iran. Methods. One hundred and twenty (120) patients candidate for valvular heart surgery were selected for this study. Careful history and physical examination were undertaken from rheumatological stand points. The most sensitive screening serologic tests were also assayed. Results. The result of this study showed that 53.3% were male and 46.6% were female with mean age of 48.18 ± 17.65 years old. 45.8% of the patients had history of nonmechanical joint disease, 14.2% had history of rheumatological conditions in their family, and 30% had history of constitutional symptoms. 29.8% had positive joint dysfunction findings in their physical examination while 25.8% had anemia of chronic disease. Positive Rheumatoid factor (RF), anticyclic citrullinated peptide (CCP, ACPA), C-reactive protein (CRP), antinuclear antibody (ANA), abnormal urine and elevated erythrocyte sedimentation rate (ESR) were 34, 2.5, 26.7, 4.2, 5, and 36.7%, respectively. Antineutrophil cytoplasmic antibody (ANCA) and antiphospholipid (APL) were positive in a few cases. Conclusion. The findings of this study show immunologic bases for most patients with valvular heart diseases candidate for surgery. Undifferentiated connective tissue diseases may play an important role in the pathophysiology of valvular damage.
    Full-text · Article · Oct 2012
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    • "These criteria were communicated (verbally and written) to all medical staff. It is important to note that the recommendations for prophylaxis of infective endocarditis had been changed after the criteria were established [10]. In our institution, Dhahran Health Center (DHC), MRSA isolates represents 2% in 1999, 9.7% in 2002 and 8% in 2003 based on first isolate per patient analysis [11]. "
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    ABSTRACT: To evaluate vancomycin utilization according to the adapted criteria of the Centers for Disease Control and Prevention (CDC) with a report of the effect of education program on the utilization. We evaluated the utilization of vancomycin over a 3-month period pre- and post-intervention using educational activity. In the pre-intervention period, of the 74 adult patients vancomycin was prescribed for specific treatment in 66% (n=49), empirical therapy in 26% (n=19) and as a prophylaxis in 8% (n=6). Vancomycin utilization was considered appropriate based on the CDC recommendations in 48 (65%) patients. Forty-seven (64%) patients received an appropriate dose regimen based on weight, age and creatinine clearance. Only 31% (n=23) of patients had both peak and trough levels taken around the third dose. In the post-intervention period, vancomycin was used as specific therapy in 41% (n=14) and empirically in 59% (n=20). Compliance with guidelines for empirical use of vancomycin improved from 21% in the pre-intervention phase to 85% after the intervention (P=.0001). In addition, compliance with vancomycin use in specific therapy was 100% compared to 82%. Compliance rate with vancomycin trough level monitoring increased from 35% in the pre-intervention period to 67.7% in the post-intervention period (P=0.0002). In conclusion, in addition to the utilization of CDC based criteria for vancomycin, we had shown that patient's chart review by a clinical pharmacists with a feed back to the physicians when guidelines were not met coupled with and educational efforts are effective methods to decrease inappropriate vancomycin usage.
    Preview · Article · Jan 2009
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