SUBACUTE BACTERIAL ENDOCARDITIS PROPHYLAXIS

Course overview

INFECTIVE ENDOCARDITIS (IE) IS AN INFECTION OF THE ENDOCARDIAL SURFACES OF THE HEART, WHICH INCLUDES 1 OR MORE HEART VALVES. THE INCIDENCE OF INFECTIVE ENDOCARDITIS HOSPITALIZATION IN THE UNITED STATES IS ESTIMATED AT 12.7 PER 100,000, ANNUALLY. A MAJORITY OF THE PATIENTS (57.7%) WERE MALE AND MORE THAN A THIRD WERE AT THE AGE OF 70 AND OLDER. SEVERAL RISK FACTORS PREDISPOSE PATIENTS TO IE, SUCH AS STRUCTURAL HEART DISEASE (VALVULAR DISEASE OR CONGENITAL HEART DISEASE), PROSTHETIC HEART VALVES, INDWELLING CARDIOVASCULAR DEVICE, AN INTRAVASCULAR CATHETER, CHRONIC HEMODIALYSIS, HUMAN IMMUNODEFICIENCY VIRUS INFECTION, DIABETES, OR HISTORY OF INFECTIVE ENDOCARDITIS. OTHER RISK FACTORS INCLUDE MALE OLDER THAN 60 YEARS, MALE GENDER, INTRAVENOUS (IV) DRUG USE, POOR DENTITION, OR DENTAL INFECTION. INFECTIVE ENDOCARDITIS MAY PRESENT AS ACUTE OR SUBACUTE INFECTION. ACUTE INFECTIONS PRESENT AS A RAPIDLY PROGRESSIVE DISEASE WITH HIGH FEVERS, RIGORS, AND SEPSIS. ON THE OTHER HAND, SUBACUTE BACTERIAL ENDOCARDITIS DIAGNOSIS IS OFTEN DELAYED AND PRESENTS AS NON-SPECIFIC SYMPTOMS SUCH AS WEIGHT LOSS, FATIGUE, DYSPNEA OVER SEVERAL WEEKS TO MONTHS. THERE ARE SEVERAL DIFFERENCES BETWEEN SUBACUTE BACTERIAL ENDOCARDITIS AND ACUTE BACTERIAL ENDOCARDITIS. MOST CASES OF SUBACUTE BACTERIAL ENDOCARDITIS ARE CAUSED BY PENICILLIN SENSITIVE STREPTOCOCCUS VIRIDANS, WHILE STAPHYLOCOCCUS AUREUS CAUSES MOST CASES OF ACUTE BACTERIAL ENDOCARDITIS. SUBACUTE BACTERIAL ENDOCARDITIS MOSTLY HAPPENS IN PRE-EXISTING HEART DISEASE WHILE ACUTE BACTERIAL ENDOCARDITIS MOSTLY HAPPENS IN HEALTHY HEARTS. AFTER TREATMENT, SUBACUTE BACTERIAL ENDOCARDITIS RARELY LEADS TO SEVERE CARDIAC DAMAGE; HOWEVER, MOST PATIENTS WHO SURVIVE ACUTE BACTERIAL ENDOCARDITIS OFTEN DIE OF CARDIAC FAILURE WITHIN WEEKS OR MONTHS. THIS ACTIVITY REVIEWS THE TREATMENT OF SUBACUTE ENDOCARDITIS, AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN TREATING PATIENTS WITH THIS CONDITION.