Top Things to Know: Non-Dental Invasive Procedures and Risk of Infective Endocarditis – Mandate for a Revisit A Scientific Advisory from the American Heart Association
Published: October 05, 2023
- Infective endocarditis (IE) is a rare but deadly disease with high morbidity and mortality.
- At present, most strategies to prevent IE focus on invasive dental procedures in patients at high risk of adverse IE outcomes.
- The current science advisory examines the link between non-dental invasive procedures and the risk of IE in high-risk patients (and the potential role of antibiotic prophylaxis) in light of the new evidence.
- No prospective randomized clinical trial has ever been conducted (or is likely) to determine whether antibiotic prophylaxis (AP) before an invasive procedure (dental or otherwise) reduces the risk of developing IE.
- The American Heart Association and the European Society of Cardiology endorse AP before invasive dental procedures in high-risk patients.
- Several studies (including two recent nationwide analyses) have suggested that various non-dental invasive procedures are temporally associated with the development of IE.
- These two studies used a case-crossover design to control for potential confounders but still have significant limitations. First, an underlying condition may have provoked investigation (including non-dental invasive procedures) that could cause IE. Second, no microbiological data were available to identify a causative organism linked to a specific invasive procedure. Third, data concerning the use of AP were unavailable, thereby limiting interpretation.
- Some invasive procedures may cause bloodstream infection, which could result in IE, and scrupulous sterile technique is critical. It is a good practice to educate patients and their families about the symptoms of IE so that they can alert their health care team to the possible diagnosis, thereby prompting blood cultures to enhance the likelihood of early diagnosis and initiation of appropriate antibiotic treatment.
- A review of pre-procedural antibiotic regimens concerning individual patients' IE risk is warranted.
- Further studies are imperative to validate the associations identified in recent studies, which provide the focus for this science advisory.
Citation
Baddour LM, Janszky I, Thornhill MH, Garrigos ZE, DeSimone DC, Welty-Wolf K, Baker AL, Jone P-N, Prendergast B, Dayer MJ; on behalf of the American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) and Council on Cardiovascular and Stroke Nursing. Nondental invasiveprocedures and risk of infective endocarditis: time for a revisit: a science advisory from the AmericanHeart Association [published online ahead of print October 5, 2023]. Circulation. doi: 10.1161/CIR.0000000000001180