Antimicrobial prophylaxis for bacterial endocarditis
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Vivian H Chu, MD, MHS
Vivian H Chu, MD, MHS
- Associate Professor of Medicine
- Duke University Medical Center
- Section Editor
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
Use of antimicrobial prophylaxis for prevention of bacterial endocarditis is based on theoretical advantage rather than data from clinical trials.
The 2007 American Heart Association (AHA) guideline for the prevention of infective endocarditis (IE)  made major revisions to the 1997 AHA guideline, the 2005 update of those guidelines published by the Medical Letter , and the 2006 American College of Cardiology (ACC)/AHA guideline on the management of valvular heart disease . Since the publication of the 2007 AHA guideline, the ACC/AHA guideline has been updated several times, most recently in the 2017 AHA/ACC focused update of the 2014 valvular heart disease guidelines [4,5]. The 2015 European Society of Cardiology (ESC) guidelines are largely in agreement with the American guidelines .
The theoretical basis and clinical approach for use of antimicrobial prophylaxis for prevention of bacterial endocarditis will be reviewed here . Issues related to the diagnosis and treatment of endocarditis are discussed separately. (See "Clinical manifestations and evaluation of adults with suspected native valve endocarditis" and "Antimicrobial therapy of native valve endocarditis".)
The pathogenesis of infective endocarditis (IE) is presumed to involve the following sequence of events :
●Formation of a small thrombus on an abnormal endothelial surface
- Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736.
- Antibacterial prophylaxis for dental, GI, and GU procedures. Med Lett Drugs Ther 2005; 47:59.
- American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease), Society of Cardiovascular Anesthesiologists, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48:e1.
- Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
- Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017.
- Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075.
- Durack DT. Prevention of infective endocarditis. N Engl J Med 1995; 332:38.
- Glauser MP, Francioli P. Relevance of animal models to the prophylaxis of infective endocarditis. J Antimicrob Chemother 1987; 20 Suppl A:87.
- Durack DT, Petersdorf RG. Chemotherapy of experimental streptococcal endocarditis. I. Comparison of commonly recommended prophylactic regimens. J Clin Invest 1973; 52:592.
- Seto TB. The case for infectious endocarditis prophylaxis: time to move forward. Arch Intern Med 2007; 167:327.
- Morris AM. Coming clean with antibiotic prophylaxis for infective endocarditis. Arch Intern Med 2007; 167:330.
- Strom BL, Abrutyn E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med 1998; 129:761.
- Duval X, Alla F, Hoen B, et al. Estimated risk of endocarditis in adults with predisposing cardiac conditions undergoing dental procedures with or without antibiotic prophylaxis. Clin Infect Dis 2006; 42:e102.
- Durack DT, Kaplan EL, Bisno AL. Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry. JAMA 1983; 250:2318.
- van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med 1992; 152:1869.
- Duval X, Leport C. Prophylaxis of infective endocarditis: current tendencies, continuing controversies. Lancet Infect Dis 2008; 8:225.
- Thornhill MH, Dayer MJ, Prendergast B, et al. Incidence and nature of adverse reactions to antibiotics used as endocarditis prophylaxis. J Antimicrob Chemother 2015; 70:2382.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73.
- Gould FK, Elliott TS, Foweraker J, et al. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006; 57:1035.
- Tower C, Nallapeta S, Vause S. Prophylaxis against infective endocarditis in obstetrics: new NICE guidance: a commentary. BJOG 2008; 115:1601.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 421, November 2008: antibiotic prophylaxis for infective endocarditis. Obstet Gynecol 2008; 112:1193.
- Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 2008; 118:e714.
- Dayer MJ, Jones S, Prendergast B, et al. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet 2015; 385:1219.
- Dayer M, Thornhill M. Antibiotic Prophylaxis Guidelines and Infective Endocarditis: Cause for Concern? J Am Coll Cardiol 2015; 65:2077.
- Bikdeli B, Wang Y, Kim N, et al. Trends in hospitalization rates and outcomes of endocarditis among Medicare beneficiaries. J Am Coll Cardiol 2013; 62:2217.
- Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015; 65:2070.
- Desimone DC, Tleyjeh IM, Correa de Sa DD, et al. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association's endocarditis prevention guidelines. Circulation 2012; 126:60.
- DeSimone DC, Tleyjeh IM, Correa de Sa DD, et al. Incidence of Infective Endocarditis Due to Viridans Group Streptococci Before and After the 2007 American Heart Association's Prevention Guidelines: An Extended Evaluation of the Olmsted County, Minnesota, Population and Nationwide Inpatient Sample. Mayo Clin Proc 2015; 90:874.
- Prophylaxis against infective endocarditis. National Institute for Health and Clinical Excellence, 2008 https://www.nice.org.uk/guidance/cg64 (Accessed on May 14, 2015).
- Animal studies
- Human studies
- - Prophylaxis failure
- CLINICAL APPROACH
- Patients at highest risk
- Relevant procedures
- - Dental work
- - Respiratory tract
- - Genitourinary and gastrointestinal tracts
- - Vaginal or cesarean delivery
- - Skin or musculoskeletal tissue
- Patients on antibiotics
- TRENDS IN ENDOCARDITIS INCIDENCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS