Fabio Chirillo1, Pompilio Faggiano2, Moreno Cecconi3, Antonella Moreo4, Angelo Squeri5, Oscar Gaddi6, Enrico Cecchi7. 1. Unità Operativa Complessa di Cardiologia, Ospedale Ca' Foncello, Treviso, Italy. Electronic address: fchirillo@tin.it. 2. Cattedra di Cardiologia, Università di Brescia e U.O. Cardiologia, Ospedali Civili, Brescia, Italy. 3. Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy. 4. Dipartimento Cardiologico, Ospedale Niguarda Ca' Granda, Milan, Italy. 5. Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliera Universitaria di Parma, Parma, Italy. 6. Dipartimento di Cardiologia, Ospedale di Reggio Emilia, Reggio Emilia, Italy. 7. Dipartimento di Cardiologia, Ospedale Maria Vittoria, Torino, Italy.
Abstract
UNLABELLED: Efficacy and safety of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) in patients with predisposing cardiac condition (PCC) undergoing invasive procedures is still debated. We sought to assess the prevalence of PCC, the type of interventional procedures preceding the onset of symptoms, and the usefulness of AP in a large cohort of consecutive patients with definite IE. METHODS: We examined 677 (median age 65.34 years; male 492 [73%]) consecutive patients with IE enrolled from July 2007 through 2010 into the Italian Registry of Infective Endocarditis. RESULTS: Predisposing cardiac condition was present in 341 patients (50%).Thirty-two patients (4.7%) underwent dental procedures. Of 20 patients with PCC undergoing dental procedure, 13 had assumed AP. Viridans group streptococci were isolated from blood cultures in 8 of 20 patients with PCC and prior dental procedure. Nondental procedures preceded IE in 139 patients (21%). They were significantly older and had more comordibities compared with patients undergoing dental procedures. Predisposing cardiac condition was identified in 91 patients. Perioperative antimicrobial prophylaxis was administered to 67 patients. Staphylococcus aureus was the most frequent causative agent. Cardiac surgery was necessary in 85 patients (20 with prior dental and 65 with nondental procedure). Surgical mortality (12% vs 0%, P = .03) and hospital mortality (23% vs 3%, P = .001) were significantly larger among patients with nondental procedures. CONCLUSIONS: In a large unselected cohort of patients with IE, the incidence of preceding dental procedures was minimal. The number of cases potentially preventable by means of AP was negligible. Nondental procedures were more frequent than dental procedures and were correlated with poorer prognosis.
UNLABELLED: Efficacy and safety of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) in patients with predisposing cardiac condition (PCC) undergoing invasive procedures is still debated. We sought to assess the prevalence of PCC, the type of interventional procedures preceding the onset of symptoms, and the usefulness of AP in a large cohort of consecutive patients with definite IE. METHODS: We examined 677 (median age 65.34 years; male 492 [73%]) consecutive patients with IE enrolled from July 2007 through 2010 into the Italian Registry of Infective Endocarditis. RESULTS: Predisposing cardiac condition was present in 341 patients (50%).Thirty-two patients (4.7%) underwent dental procedures. Of 20 patients with PCC undergoing dental procedure, 13 had assumed AP. Viridans group streptococci were isolated from blood cultures in 8 of 20 patients with PCC and prior dental procedure. Nondental procedures preceded IE in 139 patients (21%). They were significantly older and had more comordibities compared with patients undergoing dental procedures. Predisposing cardiac condition was identified in 91 patients. Perioperative antimicrobial prophylaxis was administered to 67 patients. Staphylococcus aureus was the most frequent causative agent. Cardiac surgery was necessary in 85 patients (20 with prior dental and 65 with nondental procedure). Surgical mortality (12% vs 0%, P = .03) and hospital mortality (23% vs 3%, P = .001) were significantly larger among patients with nondental procedures. CONCLUSIONS: In a large unselected cohort of patients with IE, the incidence of preceding dental procedures was minimal. The number of cases potentially preventable by means of AP was negligible. Nondental procedures were more frequent than dental procedures and were correlated with poorer prognosis.
Authors: Judith Bergadà-Pijuan; Michelle Frank; Sara Boroumand; Frédérique Hovaguimian; Carlos A Mestres; Robert Bauernschmitt; Thierry Carrel; Bernd Stadlinger; Frank Ruschitzka; Annelies S Zinkernagel; Roger D Kouyos; Barbara Hasse Journal: Infection Date: 2022-08-16 Impact factor: 7.455