Predisposing cardiac conditions, interventional procedures, and antibiotic prophylaxis among patients with infective endocarditis.
Efficacy and safety of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) in patients with predisposing cardiac condition (PCC) undergoing invasive procedures is still debated. We sought to assess the prevalence of PCC, the type of interventional procedures preceding the onset of symptoms, and the usefulness of AP in a large cohort of consecutive patients with definite IE.



We examined 677 (median age 65.34 years; male 492 [73%]) consecutive patients with IE enrolled from July 2007 through 2010 into the Italian Registry of Infective Endocarditis.



Predisposing cardiac condition was present in 341 patients (50%).Thirty-two patients (4.7%) underwent dental procedures. Of 20 patients with PCC undergoing dental procedure, 13 had assumed AP. Viridans group streptococci were isolated from blood cultures in 8 of 20 patients with PCC and prior dental procedure. Nondental procedures preceded IE in 139 patients (21%). They were significantly older and had more comordibities compared with patients undergoing dental procedures. Predisposing cardiac condition was identified in 91 patients. Perioperative antimicrobial prophylaxis was administered to 67 patients. Staphylococcus aureus was the most frequent causative agent. Cardiac surgery was necessary in 85 patients (20 with prior dental and 65 with nondental procedure). Surgical mortality (12% vs 0%, P = .03) and hospital mortality (23% vs 3%, P = .001) were significantly larger among patients with nondental procedures.



In a large unselected cohort of patients with IE, the incidence of preceding dental procedures was minimal. The number of cases potentially preventable by means of AP was negligible. Nondental procedures were more frequent than dental procedures and were correlated with poorer prognosis.
Unità Operativa Complessa di Cardiologia, Ospedale Ca' Foncello, Treviso, Italy. Electronic address: fchirillo@tin.it.
Fabio
F
Chirillo
Cattedra di Cardiologia, Università di Brescia e U.O. Cardiologia, Ospedali Civili, Brescia, Italy.
Pompilio
P
Faggiano
Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy.
Moreno
M
Cecconi
Dipartimento Cardiologico, Ospedale Niguarda Ca' Granda, Milan, Italy.
Antonella
A
Moreo
Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliera Universitaria di Parma, Parma, Italy.
Angelo
A
Squeri
Dipartimento di Cardiologia, Ospedale di Reggio Emilia, Reggio Emilia, Italy.
Oscar
O
Gaddi
Dipartimento di Cardiologia, Ospedale Maria Vittoria, Torino, Italy.
Enrico
E
Cecchi
D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods*; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D003757:Dental Implantation; D012534:Dental Scaling; D004696:Endocarditis / Q000453:epidemiology / Q000517:prevention & control; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D019919:Prosthesis Implantation; D012307:Risk Factors; D012390:Root Canal Therapy; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000453:epidemiology*; D014081:Tooth Extraction; D014656:Vascular Surgical Procedures; D034363:Viridans Streptococci