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PubMed1993

[Situations and procedures with risk of bacterial endocarditis (intracardiac surgery excluded)].

Situations which can be considered at risk for infective endocarditis are those causing a bacteremia, which is necessary for the development of an endocarditis. Such situations can be identified by clinical studies evaluating the rate at which a bacteremia occurs after some procedures or because of lesions, then the risk of endocarditis after such a bacteremia. Without considering preexisting cardiac lesion and age, some situations seem to be at risk of subsequent endocarditis: acute bacterial infection for which antibiotherapy is necessary; procedures involving the mouth with the exception of superficial caries and bloodless supragingival prosthetic preparations; oesophageal dilatation, laser endo-oesophageal procedures, sclerosis of oesophageal varices; colonoscopy and sigmoidoscopy for cancer lesions, gastrointestinal procedures on a potentially infected gastrointestinal tract (cholecystectomy, colectomy...); tonsillectomy and adenoidectomy; naso-tracheal intubation; instrumental procedures involving the ureter or kidney, and prostatic or urinary tract biopsies and surgery; procedures performed on infected skin. In cardiac patients at high risk, in addition to the above retrograde cholangiography, colonoscopy and rectosigmoidoscopy, lithotripsy. In these situations the risk of endocarditis is probably linked to the rate of bacteremia, the size of inoculum, and the bacteria, compared with spontaneous bacteremia without any procedure, where the inoculum is low and bacteria is considered as non pathogenic. A prophylaxis has to be discussed in such situations, which are probably involved in less than 10% of endocarditis.

Adenoidectomy↗
PubMed1986

Management of vascular complications of bacterial endocarditis.

Peripheral arterial emboli that result from bacterial endocarditis may be silent or catastrophic. Cardiac surgical intervention may prevent embolism, but the guidelines for timing of intervention are unclear. An accepted approach is to intervene only if two episodes of peripheral embolism occur. Our recent experience suggests a more refined approach is in order. Eight children with active bacterial endocarditis have been treated with embolic complications. One patient with abdominal pain and GI bleeding was treated with heparin for multiple peripheral mesenteric emboli. Four patients had femoral embolectomies, one twice. Three patients developed embolomycotic aneurysms of the aorta in two cases and the common iliac in one; all were ruptured and two survived with staged reconstruction in one and extra-anatomic bypass in the other. Staph aureus and Strep viridans were the organisms involved most often. A review of the details of care in these patients leads to the following conclusions: angiographic survey reveals that most patients have multiple emboli; early embolectomy may prevent formation of infected aneurysms; Staph aureus infected patients are at risk for development of infected aneurysms; patients with large floppy vegetations in the left heart on echocardiography are at high risk for embolism; and 2 to 3 weeks from onset of endocarditis is the peak time for embolic risk.

Adolescent↗