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Healthcare and avoidance of infective endocarditis

Healthcare and avoidance of infective endocarditis. Prof.Ali M .Kassem Internal Medicine and Cardiology Department Sohag Faculty of Medicine. Agenda. The regressing role of prophylactic antibiotics in IE Physiologic Vs dental procedure related bacteremia Role of oral hygiene

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Healthcare and avoidance of infective endocarditis

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  1. Healthcare and avoidance of infective endocarditis Prof.Ali M .Kassem Internal Medicine and Cardiology Department Sohag Faculty of Medicine

  2. Agenda • The regressing role of prophylactic antibiotics in IE • Physiologic Vs dental procedure related bacteremia • Role of oral hygiene • Recent strategy for IE prophylaxis • Recommendations and summary

  3. Epidemiology of IE-Risk factors • Decrease in : • Rheumatic heart disease • Increase in: • Patients with degenerative heart disease • IV drug users • Dialysis patients • Patients without known predisposing factors

  4. The regressing role of prophylactic antibiotics in IE

  5. High-risk patients • Prosthestic cardiac valves • Previous bacterial endocarditis • Complex cyanotic heart disease • Surgically constructed systemic-pulmonary shunts or conduits

  6. Do antibiotics reduce bacteremias ? • Amoxicillin therapy causes reduction but does not eliminate bacteremia • Penicillin or ampicillin compared with placebo diminished the % of S .Viridans and anaerobes ,but no significant difference in the % of Pts with + cultures 10 minutes after tooth extraction AHA ,2007

  7. Physiologic Versus Dental Procedure Related Baceremia

  8. Physiologic Versus Dental Procedure Related Baceremia. cont

  9. Physiologic Versus Dental Procedure Related Baceremia .cont • Tooth brushing 2 times a day for 1 year had >150,000 times greater risk of baceremia than a single tooth extraction • Exposure to bacteremia from routine daily activities in 1 year may be 5.6 million times greater than that resulting from a single tooth extraction • International Endocarditis workshop ,Chicago May 7-9 ,2004

  10. Role of oral hygieneIn patients with poor oral hygiene ,the frequency of positive blood culture just prior to dental extraction may be similar to that following extractionPoor oral hygiene is associated with increased risk of spontaneous bacteremiaRoperts GJ Pediatr Cardiol 1999 ,20 :317

  11. Role of oral hygiene .cont Saliva provides significant antimicrobial activity for the oropharynx • It contains a variety of specific innate and specific immune components • Saliva flow is stimulated by eating- chewing • Unstimulated flow 0.25-0.35 ml/min • Stimulated flow increases 4-6 ml/ min

  12. Role of oral hygiene .cont • Decrease flow or lack of salivary secretion can lead to changes in oropharyngeal colonization • Teeth become more adherent to bacteria • Antimicrobial effects of saliva are absent • Oropharyngeal colonization takes place

  13. Role of oral hygiene .contXerostomia- chronic dry mouthCauses : • Stress and anxiety • Smoking • Tubes that transverse the oral cavity • Dehydration • Sjogren;s Syndrome • Medications

  14. Role of oral hygiene .contImpact of ICU Environment • Within 48 hours of hospital admission oropharyngeal flora of critically ill patients undergoes a change to predominantly gram negative organisms. • High colonization of MRSA and Pseudomonas on dental plaque of patients in the ICU.

  15. Role of oral hygiene .contImpact of ICU Environment Barriers for providing oral care in the ICU: • Limited access to oral cavity ? tubes • Tubes that transverse the oral cavity • Potential for the development of bacteremia • Concern about tube dislodgement • Time consuming and low priority • Requires little skill- “I didn’t go into the ICU to do oral care”

  16. Recommendations Health care professionals should be aware of : • The global approach to patients at risk of IE • Recognizing and educating the at risk patients • Regular dental examinations for all dentate patients • Daily oral and skin hygiene provided for disabled and critically ill patients

  17. Recommendations .cont People at risk should receive clear and consistent information about IE prevention, including: • Maintaining a high level of oral health • The benefits and risks of antibiotic prophylaxis, and an explanation of why antibiotic prophylaxis is no longer routinely recommended • Symptoms that may indicate IE and when to seek expert advice • The risks of undergoing invasive procedures

  18. Summary

  19. Please don’t forget us

  20. Thank you

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