[The prevention of infective endocarditis toward a surprising paradigm: antibiotic prophylaxis restricted to patients at risk of endocarditis with poor outcome].
The rationale for antibiotic prophylaxis of infective endocarditis is based on reproducible evidence of experimental infection induced by bacteremia in previously damaged endothelium. However, in the absence of clinical evidence from randomized studies, the extensive practice of antibiotic prophylaxis has recently been limited to high-risk cardiac conditions to prevent poor outcome infective endocarditis. In addition, the new paradigm for prevention of endocarditis requires a comprehensive approach to extracardiac risk conditions (bacterial virulence, comorbidity, demographic variables), which may be responsible for an unfavorable clinical course, independent of preexistent cardiac disease. In particular, prevention of nosocomial infective endocarditis deserves special attention over and above the periprocedural antibiotic prophylaxis suggested by scientific guidelines, mainly focused on community-acquired endocarditis.
La Canna
Giovanni
G
Dipartimento Cardio-Toraco-Vascolare, Ospedale San Raffaele, Milano. lacanna.giovanni@hsr.it
Arendar
Iryna
I
Fumagalli
Luca
L
Alfieri
Ottavio
O
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D017714:Community-Acquired Infections / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control*; D004697:Endocarditis, Bacterial / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents