Are new recommendations on the prevention of infective endocarditis applicable in our environment?

Abstract

Introduction. Over half a century ago the process of prevention of infective endocarditis in patients with predisposed cardiac diseases was started. The application of prevention has been based on the fact that infective endocarditis is preceded by bacteraemia, which can be caused by some invasive diagnostic and therapeutic procedures, and whose development can be prevented by applying antibiotics before an intervention. According to the latest guidelines of the European Society of Cardiology published this year, prevention is recommended only in high risk patients with previous infective endocarditis, prosthetic valves, cyanotic congenital heart diseases without surgical repair or with residual defects, palliative shunts or conduits, congenital heart diseases with complete repair with prosthetic material up to six months after the procedure (surgery or percutaneous intervention), and when the residual defect persists at the site of implantation of a prosthetic material. In addition, antibiotic prophylaxis is limited to dental procedures with the manipulation of gingival or periapical region of the teeth or perforation of the oral mucosa. Objective. The aim of this testing was to confirm whether these novelties in recommendations were applicable in our environment. Methods. Fifty-seven patients (44 men and 13 women) with infective endocarditis were included in the testing. Infective endocarditis was diagnosed in 68% of patients based on two major criteria and in 32% based on one major and three minor criteria. Results. In 54.4% of patients the entry site of infection could be determined. Twenty-one percent of patients developed infection after a dental intervention, 17.5% of patients the infection occurred after a skin/soft tissue lesion, whereas urinary infection preceded infective endocarditis in 14% of patients and bowel diverticulosis was a possible cause in of 1.75% of patients. In all cases with infective endocarditis preceded by the dental intervention, antibiotic prophylaxis was not applied due to absent data of heart disease or negligence. Conclusion. In our country a high incidence of infective endocarditis following dental procedures has been observed. One of possible reasons is poor oral hygiene. Its improvement and a regular dental control, as well as the individual risk assessment of intervention and conditions under which the intervention is performed could determine risk reduction for the development of infective endocarditis.

Keywords

• infective endocarditis
• prevention
• guidelines