PREVENTION OF INFECTIVE ENDOCARDITIS: PROCEDURES ASSOCIATED WITH RISK OF BACTEREMIA
After assessing a patient’s intrinsic risk for developing IE, the next step in considering the role of antibiotic prophylaxis is to determine whether the planned procedure carries a significant risk of bacteremia with organisms known to cause IE. Although there are dozens of papers in the literature that assess post-procedural bacteremia, the interpretation of their results is difficult because of marked differences in several parameters, including the following:- Time at which cultures were obtained (from 1 to 20 minutes post procedure)- Isolates considered significant positives (e.g., inclusion or exclusion of coagulase-negative staphylococci or anaerobic bacteria)- Definitions of significant bacteremia (by both type of bacteria, quantity recovered, and time from procedure)- Differences in blood culture methods- Inability to truly standardize all procedures being performed (e.g., chewing)Despite these limitations to the available data, it is possible to stratify procedures according to a relatively high or low likelihood of inducing bacteremia with organisms known to cause IE. The highest risk procedures include the following:- Most dental procedures, generally including any invasive procedure or procedures involving gingival manipulation- Tonsillectomy- Esophageal stricture dilation- Variceal sclerotherapy- Many genitourinary tract procedures (including transrectal biopsy of the prostate)- Most open surgical operations involving respiratory, intestinal, or genitourinary tract mucosaA group of lower risk procedures includes the following1-2’10-12:- Noninvasive dental procedures, including orthodontic band adjustments and fluoride treatments- Esophagogastroduodenoscopy with or without biopsy- Colonoscopy with or without biopsy- Uterine dilatation and curettage- Spontaneous vaginal delivery or uncomplicated caesarian section- Flexible bronchoscopy- Transesophageal echocardiography*48/348/5*
