Bacterial Endocarditis
Carditis
Pathophysiology
Bacteria that are prone: Viridans strep (mutans/sanguis), staph aureus
Risk factors
IVDU
Dental procedures
Previous valve surgery
but more likely to be caused by low risk frequent i.e. brushing teeth
Prophylaxis
(prevention of bacteraemia during periods of abnormal epithelial tissue/clot formation)
(no clinical trial evidence)
Floss, brush, regular dental visits, avoid IVDU
NICE guidelines suggest no role for prophylaxis as brushing teeth higher risk
AHA recommends WHEN
if allergy or already on penicillin prophylaxis use cephalexin/clindamycin/azithromycin (or vanc for GIT/GUT
Pathophysiology
- abnormal epithelial tissue
- small clot
- secondary infection of the clot by transient bacterial in blood
- bacteria proliferate into a vegetation
Bacteria that are prone: Viridans strep (mutans/sanguis), staph aureus
Risk factors
IVDU
Dental procedures
Previous valve surgery
but more likely to be caused by low risk frequent i.e. brushing teeth
Prophylaxis
(prevention of bacteraemia during periods of abnormal epithelial tissue/clot formation)
(no clinical trial evidence)
Floss, brush, regular dental visits, avoid IVDU
NICE guidelines suggest no role for prophylaxis as brushing teeth higher risk
AHA recommends WHEN
- unrepaired cyanotic congenital heart disease
- for 6 months post prosthetic repair of CHD
- Prosthetic heart valves
- Valvular regurgitation in heart transplant
- Previous IE
- Dental (not orthodontic) work
- Incision of respiratory tract (T+As, bronchial biopsy)
- I+D of skin/musculoskeletal abscess
- Vaginal Delivery
- GUT/GIT infection
- enterococcal colonisation of bladder > eradicate prior to GUT surgery
if allergy or already on penicillin prophylaxis use cephalexin/clindamycin/azithromycin (or vanc for GIT/GUT