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PubMed2004

Bacterial endocarditis prophylaxis.

Bacterial endocarditis (BE) is a disease resulting from the association of morphological alterations of the heart and bacteraemia originating from different sources that at times can be indiscernible (infectious endocarditis). It is classified on the basis of the morphological alteration involved, depending on the clinical manifestations and course of illness, which varies according to the causative microorganism and host conditions (for example, it is characteristic in I.V. drug users). The most common microorganisms involved are: Streptococcus viridans (55%), Staphylococcus aureus (30%), Enterococcus (6%) and HACEK bacteria (corresponding to the initials: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella and Kingella), although on occasions it can also be caused by fungi. The oral microbiological flora plays a very important role in the aetiopathogenesis of BE, given that the condition may be of oral or dental origin. This paper will deal with the prevention of said bacteraemia. Prophylaxis will be undertaken using amoxicillin or clindamycin according to action protocols, with special emphasis placed on oral hygiene in patients with structural defects of the heart.

Amoxicillin↗
PubMed1987

In vitro correlation of platelet aggregation with occurrence of disseminated intravascular coagulation and subacute bacterial endocarditis.

Platelet-bacterial interactions were examined in vitro by incubating organisms isolated from patients with septicemia with normal platelet-rich plasma. The potency of various species of gram-positive and gram-negative bacteria to induce irreversible platelet aggregation was then determined in an aggregometer. The aggregation curves produced by the bacteria resembled the normal platelet response to collagen and were impeded by the presence of aspirin. Strains of Staphylococcus aureus and Pseudomonas aeruginosa isolated from 25 different patients produced maximum increases in light transmission and irreversible platelet aggregation with relatively rapid mean aggregation times; six of these patients had clinical and laboratory evidence of disseminated intravascular coagulation. In contrast, isolates of alpha streptococcus and Staphylococcus epidermidis induced irreversible platelet aggregation much less commonly and were associated with considerably longer mean aggregation times. None of the latter group of patients had evidence of disseminated intravascular coagulation. Isolates of bacteria from a small number of patients with subacute bacterial endocarditis uniformly induced irreversible platelet aggregation. Addition of paired bacterial isolates to normal platelet-rich plasma demonstrated a synergistic aggregation response. These data suggest that a relative hierarchy exists in bacterial strain potency to induce irreversible platelet aggregation. The rapidity and degree of aggregation in vitro correlated well with the clinical and laboratory evidence for subacute bacterial endocarditis and disseminated intravascular coagulation in vivo. These observations may provide useful adjunctive laboratory information to help establish the diagnosis of subacute bacterial endocarditis, especially in the clinical setting where the classical findings of endocarditis are not obvious during initial presentation.

Blood Platelets↗
PubMed1996

Aortic aneurysm complicating bacterial endocarditis in childhood.

Bacterial endocarditis is an uncommon diagnosis in childhood with significant morbidity and mortality. Aortic aneurysm as a complication is well described in adults but there are few reports in the paediatric literature. Two children with bacterial endocarditis are described, whose illnesses were complicated by aortic aneurysm formation requiring surgical intervention.

Adolescent↗
PubMed1985

[Prevention of bacterial endocarditis].

Prevention of bacterial endocarditis is aimed at limiting the frequency, size, and duration of transient bacteremia with subsequent bacterial implantation on valvular endothelium in patients with cardiopathy. Any procedure involving mucosa rich in normal flora or an infectious site can result in bacteremia, which can be minimized by selecting diagnostic and therapeutic procedures which are least traumatic. In addition, proper antibiotic prophylaxis should be administered according to the most frequently encountered bacteria: Streptococcus viridans during dental manipulations, enterococci during urogenital or intestinal procedures, and staphylococcal species from skin lacerations or cardiac surgery. The different antibiotic prophylactic regimens suggested at the present time vary according to the patient and the particular circumstances surrounding his illness. These regimens should be modified according to future epidemiologic findings in bacterial endocarditis.

Anti-Bacterial Agents↗
PubMed1982

Bacterial endocarditis in pregnancy.

Bacterial endocarditis in pregnancy is uncommon but serious. A case is presented of subacute bacterial endocarditis with severe aortic and mitral valvular insufficiency and with associated multiple systemic and cerebral emboli. Therapy consisted of cesarean section at 33 weeks' gestation followed by aortic and mitral valve replacement; there was no maternal or fetal mortality. The English literature on infective endocarditis complicating pregnancy is reviewed.

Adult↗
PubMedDate not supplied

[Bacterial endocarditis in childhood].

BACKGROUND: Bacterial endocarditis in childhood is a rare but serious disease. The group of children with congenital heart disease at risk to develop bacterial endocarditis increases, because more children survive with advanced medical and surgical management. Rheumatic Fever as predisposing heart disease decreases and is of reduced importance. PATIENTS: From 1983 to 1993 16 patients in the age of 0.3 to 17.6 years (mean 10.6 years) were received by the Department of Pediatric Cardiology of the University Children's Hospital Vienna with the diagnosis "bacterial endocarditis". A congenital heart disease was known previously in 13 cases: 4 children had VSD, 2 children had Tetralogy of Fallot, 1 child had a single ventricle and an infundibular pulmonary stenosis, 4 children had pulmonary atresia, 1 child had a cleft of the mitral valve, and 1 child had a coronary artery fistula. Moreover, 1 child had a mitral valve prolapse with valvular regurgitation as a consequence of Marfan-Syndrome. 6 children with congenital heart disease had been treated surgically previously. METHODS: Medical data of all patients with the diagnosis of "bacterial endocarditis" between 1983 and 1993 were analysed. It was this period when echocardiography was used for the first time to contribute to diagnosis and course control. RESULTS: In 11 of 16 cases positive blood cultures were obtained. Mostly Streptococcus viridans (4 cases) and Staphylococcus aureus (3 cases) were isolated. During the parenteral therapy with antibiotics 9 children suffered as a side effect from a drug induced fever and/or decreasing leucocytes and thrombocytes or a rash. In addition to the antibiotic therapy 8 children were treated surgically. One child died immediatly after the operation. 15 of the 16 patients with endocarditis survived. CONCLUSIONS: With children with known heart disease the recommendations for the prevention of bacterial endocarditis have to be strictly followed and every long ongoing feverish disease has to be carefully examinated.

Adolescent↗
PubMed1989

Pregnancy complicated by bacterial endocarditis.

In conclusion, bacterial endocarditis is a rare but very serious pregnancy complication that may lead to maternal death. The predisposing factors for the development of endocarditis appeared to have changed during the past two decades. Intravenous drug abuse, rather than rheumatic and congenital heart defects, is emerging as a major cause of endocarditis. Importantly, diagnostic evaluation and therapy during pregnancy are essentially identical to those for nonpregnant patients.

Endocarditis, Bacterial↗
PubMed1991

[Prophylaxis of the bacterial endocarditis in dental surgery].

Bacterial endocarditis is a disease with high morbidity and lethality. Bacteremia following diagnostic or therapeutic procedures in oral surgery may cause bacterial endocarditis. Patients with certain kinds of heart diseases are at higher risk to develop bacterial endocarditis. Especially these patients have to be protected by means of systemic and local prophylactic regimens.

Anti-Bacterial Agents↗
PubMed1979

[Therapy of bacterial endocarditis].

The successful treatment of bacterial endocarditis requires a close cooperation to a clinical microbiological laboratory. This performs blood cultures, estimation of sensitivity to the different antibiotics, if anyhow possible also quantitatively, and supervision of therapy by serum bactericidal tests. Synergistic combinations by adding one of the aminoglycosides bring the best chances for therapeutic success. Special advices are given in dependence of the numerous causative bacterial agents. Rare ones are sufficiently taken into consideration. If blood cultures remain negative, empiricial chemotherapy is recommended. Surgical treatment by operative replacement of the infected heart valves and insertion of prosthetic ones is indicated in uncontrolled infection, in severe heart failure caused by valve perforation, and in recurrent embolism. Early interventions have a much better prognosis. Special problems are connected to bacterial endocarditis in prosthetic valves. Bacterial endocarditis in drug addicts is of relatively good prognosis in spite of the frequent complications. Patients with suspicious or evident bacterial endocarditis should be transferred to centers owing sufficient diagnostic and therapeutic experiences.

Administration, Oral↗