44
Infectious Endocarditis
Table 31A. Prophylaxis of IE
Recommendations
COR LOE
Prophylaxis
Prophylaxis against IE is reasonable for the following
patients at highest risk for adverse outcomes from IE
before dental procedures that involve manipulation of
gingival tissue, manipulation of the periapical region of
teeth, or perforation of the oral mucosa:
• Patients with prosthetic cardiac valves;
• Patients with previous IE;
• Cardiac transplant recipients with valve regurgitation
due to a structurally abnormal valve; or
• Patients with congenital heart disease:
> Unrepaired cyanotic congenital heart disease,
including palliative shunts and conduits;
> Completely repaired congenital heart defect
repaired with prosthetic material or device,
whether placed by surgery or catheter intervention,
during the first 6 months after the procedure;
> Repaired congenital heart disease with residual
defects at the site or adjacent to the site of a
prosthetic patch or prosthetic device.
IIa B
Prophylaxis against IE is NOT recommended in patients
with VHD who are at risk of IE for nondental procedures
(eg, TEE, esophagogastroduodenoscopy, colonoscopy, or
cystoscopy) in the absence of active infection.
III: No
Benefit
B
Table 31B. 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 (eg, 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 32-33).
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
