This is a serious but possible occurrence in a patient with a valve prosthesis, who, sooner or later, could have sepsis; if then, in these patients, blood culture is carried out, severe infections due to odd germs can be found, which implant on the valves and present themselves as vegetations.
In some cases, these are interventions on the teeth or on the urinary and digestive tracts that move and circulate harmful germs.
Let's see what to do.
Treatment is always a highly specialized medical act.
Endocarditis prophylaxis is recommended for:
- Dental care
- Surgical acts on the airways (nasotracheal intubation)
- Surgical acts on the urinary tract (uretero-pelo-caliceal maneuvers)
- Surgical acts on the digestive tract (sclerosis of esophageal varices,
operative colonoscopies in neoplasms, cholecystectomy)
Prophylaxis takes place with:
- in dental care: amoxocillin (non-allergic patient) or clindamycin or
azithromycin or clarithromycin;
- in surgical acts, ampicillin (non-allergic patient) or vancomycin or
teicoplanin
Endocarditic vegetation represents an infectious outbreak in which the host's
defenses are scarce. The bacteria implant on the endocardium and are hardly
susceptible to antibiotic therapy. In fact, it is necessary to find a high
concentration antibiotic, of long duration of action and adequate dosage, better
if administered e.v.
Germs can be implanted:
- On native valves
- On prosthetic valves
They are:
- Valvulopathies es aortic, mitral, insufficiency, stenosis, prolapse
- Non-cyanogenic heart disease
- Valve prostheses
- Congenital cyanogenic heart disease
- Mitral ring calcifications
- Cardiac transplant
- Valve prolapse
It is possible that not all germs have the same sensitivity to penicillin; for
example enterococci resist penicillins and cephalosporins, and resist amino
glycosides. However, if they do not show resistance to amino glycosides, then
the association penicillin and amino glycoside or vancomycin and amino glycoside
can be used.
After the replacement of a heart valve with positive blood culture with these
germs, therapy should be continued for 40 days or 15 if the blood culture is
negative.
In staphylococcal endocarditis on native valve oxacillin is used for 4-6 weeks
and aminoglioside for 7-14 days.
If the germ is not sensitive to oxacillin, vancomycin or teicoplanin can be used.
If staphylococci are negative coagulases then they resist methicillin and three
molecules must be used: vancomycin + rifampicin + amino glycoside.
If therapy must be carried out regardless of the knowledge of the germ and in
consideration of whether the therapy is to be implemented on a native valve or
prosthesis. Since the suspected germ is a community staphylococcus oxacillin and
gentamicin will be used and if the patient is allergic vancomycin and gentamicin
can be used. If instead the valve is prosthetic, vancomycin + rifampicin +
gentamicin will be used.
cfr index cardiology