48
Infectious Endocarditis
Table 34A. Prophylaxis of IE
Recommendations
COR LOE
Prophylaxis
Prophylaxis against IE is reasonable before dental
procedures that involve manipulation of gingival
tissue, manipulation of the periapical region of teeth,
or perforation of the oral mucosa in patients with the
following : (Modified recommendation for 2017)
1. Prosthetic cardiac valves, including transcatheter-
implanted prostheses and homografts.
2. Prosthetic material used for cardiac valve repair, such as
annuloplasty rings and chords.
3. Previous IE.
4. Unrepaired cyanotic congenital heart disease or
repaired congenital heart disease, with residual shunts
or valvular regurgitation at the site of or adjacent to the
site of a prosthetic patch or prosthetic device.
5. Cardiac transplant with valve regurgitation due to a
structurally abnormal valve.
IIa C-LD
Prophylaxis against IE is NOT recommended in patients
with VHD who are at risk of IE for nondental procedures
(e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or
cystoscopy) in the absence of active infection.
III: No
Benefit
B
Table 34B. Diagnosis and Treatment of IE
Recommendations
COR LOE
Diagnosis
At least 2 sets of blood cultures should be obtained in
patients at risk for IE (e.g., those with congenital or acquired
VHD, previous IE, prosthetic heart valves, certain congenital
or heritable heart malformations, immunodeficiency states,
or injection drug users) who have unexplained fever for more
than 48 hours
I B
or patients with newly diagnosed le-sided valve
regurgitation.
I C
e Modified Duke Criteria should be used in evaluating a
patient with suspected IE (Tables 31–32).
I B
Cardiac CT is reasonable to evaluate morpholog y/anatomy
in the setting of suspected paravalvular infections when the
anatomy cannot be clearly delineated by echocardiography.
IIa B
TEE & TTE
TTE is recommended in patients with suspected IE to
identify vegetations, characterize the hemodynamic severity
of valvular lesions, assess ventricular function and pulmonary
pressures, and detect complications.
I B
