Infective Endocarditis Flashcards
What is Infective Endocarditis?
Bacterial infection affecting the endocardium.
What is the incidence of IE?
1 in 10,000
What bacteria is implicated in IE?
Gram positive Streptococci
Gram positive Staphylococci
Which patients are at increased risk of IE?
Patients with previous IE
Patients with prosthetic valves
Patients with congenital heart Disease- any type of cyanotic CHD, any type of CHD repaired with prosthetic valve.
- Subgroup requiring special consideration.
Acquired valvular heart disease with stenosis or regurgitation.
Hypertrophic cardiomyopathy.
Which patients are not at risk of IE?
Pacemakers
Patient with stents
What are the guidelines called for IE?
SDCEP- Antibiotic Prophylaxis against Infective Endocarditis.
NICE Clinical Guideline 64.
What clinical features are present in a patient with infective Endocarditis?
High temperature of over 38 degrees
Sweats or chills, especially at night
Breathlessness
Weight loss
Tiredness
Muscle, joint or back pain.
Why is caries prevention important for patients at risk of IE?
To avoid a bacteraemia.
If a patient didn’t know the nature of their cardiac condition, who could you contact?
GP
Cardiologist
Cardiac surgeon
What is the routine management of IE prevention?
Tell patient and parent the risk of IE and why they are at increased risk.
Risks and benefits of antibiotic prophylaxis
Why Antibiotics aren’t routinely recommended
What symptoms may indicate IE and when to seek advice
Risks of undergoing invasive procedures
Record that this discussion has taken place.
If the patient requests antibiotic prophylaxis- consult with cardia surgeon and cardiologist.
- NICE CG64.
What is the non-routine management of IE prevention?
Offer preventative advice.
- Importance of regular checkups, diet advice, OHI.
Assess patient in consultation with cardiologist and cardiac surgeon.
If antibiotic prophylaxis is indicated- ensure the patient and parent are aware of the risks and benefits, why they are at risk of IE, why antibiotic prophylaxis is not routinely recommended and the risk of undergoing invasive procedures.
Provide advice about prevention and why it is important to maintain good oral health.
Record this discussion in the notes.
What procedures are classes as an invasive dental procedure?
Anything involving the gingival margin that could elicit a bacteraemia.
Placement of matrix bands
Placement of subgingival rubber gam clamps
Subgingival restorations
SSC
Subgingival PMPR
Extractions
Incision and drainage of abscess
Surgery
Implants
What is classed as a non-invasive dental procedure?
Infiltrations or block anaesthesia
BPE
Supra-gingival PMPR, restorations, ortho bands and separators.
Removal of sutures
Radiographs
What are the risks and benefits of antibiotic prophylaxis?
Risks
- Antibiotic resistance
- C-Diff infection
- Anaphylaxis
- Nausea
- Diarrhoea
Benefits-
- may reduce the bacteraemia formed during procedure.
What is the antibiotic of choice for prophylaxis against IE?
3g Amoxicillin 60 minutes before the procedure
- arrange for the patient to take it in the practice.
Children
- 3g sachet or 250mg/5ml suspension.
- 50mg/kg.
