Name:
Monteleone: Management of Infective Endocarditis and the 2017 Guidelines
Description:
Monteleone: Management of Infective Endocarditis and the 2017 Guidelines
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/150799ab-f38d-49bd-aa52-45f1b0d71c51/thumbnails/150799ab-f38d-49bd-aa52-45f1b0d71c51.jpg?sv=2019-02-02&sr=c&sig=hL6QaeQ2z3eP0r6FgIWazr7OrmYRba2CDroCGdhGC4A%3D&st=2024-05-02T19%3A23%3A45Z&se=2024-05-02T23%3A28%3A45Z&sp=r
Duration:
T00H05M30S
Embed URL:
https://stream.cadmore.media/player/150799ab-f38d-49bd-aa52-45f1b0d71c51
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/150799ab-f38d-49bd-aa52-45f1b0d71c51/Monteleone-20Management20of20Infective20Endocarditis20and20t.mov?sv=2019-02-02&sr=c&sig=AQWp1RzWi77bpzyfWbJ5zWcxPOTUJOPYRJ7Hk%2BjyqrM%3D&st=2024-05-02T19%3A23%3A45Z&se=2024-05-02T21%3A28%3A45Z&sp=r
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
♪ MUSIC: ♪
DR. BERNIE: I do support the Guidelines, so I'm not going to stand out here and say-- However, I want people to read this and start to rethink all the Guidelines. Are they still as strong as they were in 2017, or does this create some concern?
♪ MUSIC: ♪ Hi, Dr. Bernie here, and welcome again to Practice Impact Extra. Infective endocarditis. Is it time to review the Guidelines? Here is the question: When are antibiotic prophylactic regimens for endocarditis indicated for patients undergoing dental procedures? Let me present the 2017 Guideline recommendation regarding endocarditis prophylaxis.
♪ MUSIC: And this is what they commented and published: "Prophylaxis against infective endocarditis is reasonable before dental procedures that involve manipulation of the gingival tissue, periapical teeth, or even perforation of the oral mucosa in patients with: Prosthetic cardiac valves, including the TAVR procedure and homografts; prosthetic material used in cardiac valve repair; previous endocarditis; unrepaired cyanotic congenital heart disease; cardiac transplantation with valve regurgitation due to a structurally abnormal valve." So, those were the five, what I would consider, recommendations for reasonable antibiotic endocarditis prophylaxis.
♪ MUSIC: The consensus of the writing group is that antibiotic prophylaxis is reasonable for the subset of patients who are at increased risk of developing endocarditis and at high risk of experiencing adverse outcomes from infective endocarditis. And these are reasonable guidelines to have identified these patients who are at increased risk. However, there is continuing debate over the efficacy of antibiotic prophylaxis before invasive dental procedures.
♪ MUSIC: Recent studies may suggest a need for modification of the risk categories. There is data suggesting a steady rise in the number of cases of infective endocarditis. And really what is disconcerting is that the number of streptococcal cases appear to be also rising significantly. A study published in June 2018, in JACC, asked the question: "What are the clinical and microbiological features of infective endocarditis among patients with bicuspid aortic valve or mitral valve prolapse?
♪ MUSIC: And how do they compare with those of infective endocarditis among patients with or without guideline indications for antibiotic prophylaxis?" This analysis involved 3,208 consecutive patients who were enrolled in the Infective Endocarditis Registry at 31 Spanish hospitals. Patients were classified: high-risk, and were recommended antibiotics; low or moderate risk without antibiotic prophylaxis; and those with infective endocarditis with bicuspid aortic valve or mitral valve prolapse.
♪ MUSIC: Looking at the data, bicuspid aortic valve and mitral valve prolapse patients had a higher incidence of streptococcal virulence infective endocarditis-- even higher than did the high-risk and low or moderate risk group of patients seen with a similar pattern of infective endocarditis from suspected dental origin. So, a higher incidence in the bivalvular and the MVP group. These individuals also had a similar complication rate as high-risk and more intracardiac complications than patients did in the low or moderate risk group.
♪ MUSIC: Bothersome. As a result, the research has concluded that both MVP and bivalvular aortic valve should really be considered high-risk infective endocarditis condition. So, what are the take-home points here? Number one, I support the 2017 reasonable evidence-based American Heart Association Guidelines for infective endocarditis prophylaxis.
♪ MUSIC: However, I want to make you aware that there are several recent studies that raised important questions regarding the present impact of the American Heart Association Guidelines, and underline the need for an ongoing monitoring of antibiotic prophylaxis prescribing practices, particularly as it relates to both mitral valve prolapse and bicuspid aortic valves. So, thanks again for joining me, and see you next time on Practice Impact Extra.
♪ MUSIC: ♪