PREVENTION OF INFECTIVE ENDOCARDITIS: MISCELLANEOUS RISK FACTORS
Although structural heart diseases are the most studied risk factors for IE, a few other risk factors are worth noting. It is unclear how to quantify the risks from these risk factors, or how their presence may or may not affect the decision to offer antibiotic prophylaxis.Previous endocarditis, with or without current structural abnormalities on echocardiography, should be considered a high-risk condition.Diabetes has been identified as a risk factor for IE in several series. It is not clear whether this increased risk is due to microscopic endocardial damage or the relative immunodeficiency associated with diabetes.Chronic renal disease is common in patients with advanced diabetes but was shown to be an independent risk factor in a large study.Nosocomial endocarditis accounts for 10% to 20% of all endocarditis cases in most published series. Furthermore, patients who acquire endocarditis on the inpatient wards are more likely to contract IE with Staphylococcus aureus or Enterococcus, and thus have a significantly higher overall mortality rate than outpatients who contract IE. Careful attention must be paid to inpatients who are going to undergo invasive procedures or who have longstanding indwelling central venous catheters.Systemic lupus erythematosus and the antiphospholipid antibody syndrome are both likely elevate a patient’s risk of contracting IE. This is most likely due to the 25% to 75% chance of clinically significant valvular disease in patients with these diseases. Especially in the presence of a heart murmur or any history of symptoms potentially related to valve disease, a cardiac work-up should be undertaken in these patients prior to making a determination regarding antibiotic prophylaxis for IE.The true effect of immunodeficiency on the development of IE is unknown. Other immunodeficiencies (human immunodeficiency virus infection, organ transplants) have not been specifically identified as risks for IE, as patients with these conditions have not been included to any significant degree in the older studies that form the basis for current recommendations.*47/348/5*
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Categories: Anti-Infectives |
