American Academy of Pediatrics eBooks · 2018 · 97 citations · 0 references
MedicineInfectious DiseasesMicrobiologyBacteriologyInfection PreventionMedical MicrobiologyAntibiotic ProphylaxisAntimicrobial ProphylaxisInfective EndocarditisProphylactic Antimicrobial UseSurgical ProphylaxisTreatment Of EndocarditisAntibiotic Prophylaxis In SurgeryBacterial Infection PreventionBlood Culture-negative EndocarditisDuration Of Prophylactic AntibioticsEndocarditis-associated BacteremiaInfective Endocarditis ProphylaxisSystemic-to-pulmonary Shunt SurgeryTiming Of Prophylactic Antibiotics
Transient bacteremia from dental or surgical procedures can seed damaged heart valves, but only a few bacterial species typically cause endocarditis and predicting which patients or procedures will lead to infection is impossible, though certain cardiac conditions and procedures are more frequently associated with the disease. The study proposes using prophylactic antibiotics for high‑risk patients undergoing procedures that most likely generate bacteremia with organisms that commonly cause endocarditis.
SURGICAL and dental procedures and instrumentations involving mucosal surfaces or contaminated tissue commonly cause transient bacteremia that rarely persists for more than 15 minutes. Blood-borne bacteria may lodge on damaged or abnormal heart valves or on the endocardium or the endothelium near congenital anatomic defects, resulting in bacterial endocarditis or endarteritis. Although bacteremia is common following many invasive procedures, only a limited number of bacterial species commonly cause endocarditis. It is impossible to predict which patient will develop this infection or which particular procedure will be responsible. Certain cardiac conditions are more often associated with endocarditis than others (Table 1). Furthermore, certain dental and surgical procedures are much more likely to initiate the bacteremia that results in endocarditis than are other procedures (Table 2). Prophylactic antibiotics are recommended for patients at risk for developing endocarditis who are undergoing those procedures most likely to produce bacteremia with organisms that commonly cause