Endocarditis

Question 1

What is the most common pathogen responsible for

bacterial endocarditis?

Answer 1

Viridans streptococci (alpha-hemolytic streptococci) are the
most common followed by staphylococcus aureus and
enterococcus.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 237.

Question 2

How does the incidence and severity of endocarditis
differ when it affects the right-sided heart valves
compared to the left-sided heart valves?

Answer 2

In the general population, left-sided endocarditis is more
common and typically occurs as the result of bacteremia and
carries a higher mortality rate than right-sided endocarditis. In
injection drug users, however, right-sided endocarditis is more
prevalent.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 318.

Question 3

How are drug and alcohol abuse related to infective

endocarditis?

Answer 3

A common complication of injection drug abuse is infective
endocarditis. The frequency of injection and the concomitant
presence of HIV are factors that increase the risk of
endocarditis dramatically. The mortality rate among injection
drug abusers who develop endocarditis is about 35% and
increases in immunocompromised patients. Strangely, a
concomitant diagnosis of alcohol abuse appears to decrease
the risk of endocarditis in this population.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 318.

Question 4

What types of procedures warrant antibiotic

prophylaxis in patients at risk for endocarditis?

Answer 4

Oral/dental procedures involving perforation of the oral mucosa
or gingival manipulation and respiratory procedures involving
biopsy or incision of the mucosa. It is no longer recommended
for routine gastrointestinal or genitourinary procedures and is
not indicated for bronchoscopy unless it involves biopsies.
Miller RD. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill
Livingstone; 2010: 1047-1048.

Question 5

What patients are candidates for antibiotic

prophylaxis to prevent endocarditis?

Answer 5

Patients with prosthetic heart valves, unrepaired cyanotic
congenital heart disease, congenital heart that has been
repaired with prosthetic devices within the past 6 months or was
repaired but has residual defects, and patients who have
undergone cardiac transplantation with valvuloplasty.
Miller RD. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill
Livingstone; 2010: 1047-1048.