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Durack DT, Lukes AS, Bright DK New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994; 96:(3)200-209
Thornhill MH, Dayer MJ, Forde JM, Corey GR, Chu VH, Couper DJ Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. Br Med J. 2011; 342
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I Guidelines on the Prevention, Diagnosis, and Treatment of Infective Endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009; 30:(19)2369-2413
Griffin MR, Wilson WR, Edwards WD, O'Fallon WM, Kurland LT Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981. J Am Med Assoc. 254:(9)1199-1202
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Infective endocarditis: the impact of the nice guidelines for antibiotic prophylaxis

From Volume 39, Issue 1, January 2012 | Pages 6-12

Authors

Martin H Thornhill

MBBS, BDS, PhD, MSc, FDS RCS(Edin), FDS RCSI, FDS RCS(Eng)

Professor of Oral Medicine, Department of Oral and Maxillofacial Medicine and Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK

Articles by Martin H Thornhill

Abstract

Infective endocarditis (IE) is a serious, life-threatening disease and oral bacteria are implicated in 35-45% of cases. This has led to the development of guidelines recommending the use of antibiotic prophylaxis (AP) prior to invasive dental procedures in patients at risk of IE. There is considerable controversy about the value of AP in preventing IE, resulting in guideline changes and different guidelines in different parts of the world. In March 2008, NICE recommended the complete cessation of AP prior to dental procedures in the UK. The effects of this controversial change were not entirely as anticipated and may provide important lessons about the role of AP in preventing IE.

Clinical Relevance: The debate over the value of providing antibiotic prophylaxis to prevent infective endocarditis in patients undergoing invasive dental procedures is of importance to dentists worldwide. The effect of the NICE guidelines on antibiotic prophylaxis prescribing and incidence of infective endocarditis in the UK has contributed important new evidence to this ongoing debate.

Article

Infective endocarditis (IE) is an infection of the endocardial lining of the heart. It most often affects the heart valves, where it may cause vegetations to develop. These are accumulations of platelets, fibrin and inflammatory cells that are heavily infected with micro-organisms and form fleshy lumps on the valve surfaces. These vegetations can stop the valves from working efficiently, leading to leakage, regurgitation and heart failure. In addition, they release bacteria into the circulation and fragments of the vegetations may break off, releasing infected emboli into the circulation to affect distant sites. Fortunately, IE is rare, but the diagnosis is difficult as initially the symptoms can be subtle or difficult to distinguish from other infections, these include:

However, the Duke criteria1 for the clinical diagnosis of IE have helped to improve the investigation and early diagnosis of the disease. This is important, since the early use of high dose antibiotic therapy can significantly improve outcomes. Nonetheless, IE is still associated with an acute mortality of around 17%2 and a high proportion of patients who survive will have long-standing heart valve damage that often requires surgery and is associated with reduced long-term survival. IE is therefore a serious disease and a major concern for affected patients, their cardiologists and cardiothoracic surgeons.3

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