Infective endocarditis Abx prophylaxis for the highest risk

Infective endocarditis • Abx prophylaxis for the highest risk pts • Good oral hygiene & regular dental review more important than Abx prophylaxis • Aseptic measures during any invasive procedure ESC 2015

OPTIMAL ORAL CARE

Highest risk procedures • Dental when gingival manipulation, perforation • NO for respiratory, gastro/colonoscopy, cystoscopy, ob/gyn, skin & soft tissue

Highest risk for IE Annuloplasty rings & chords Cardiac transplant with valve regurgitation due to a structurally abnormal valve AHA 2017

Abx for IE prevention

Abx for IE prevention Mackie AS et al. 2016: 1 -7

Abx for IE prevention Lancet. 2015 Mar 28; 385(9974): 1219 -28

Abx for IE prevention

Non specific prevention • Dental • Wounds • Bacterial carriage, e. g. MRSA • Abx for infection, eliminate sepsis-> bf foreign material • No piercing/tattooing • Limit infusion catheters/invasive procedures

Rheumatic fever • 1 ry prophylaxis -> Rx of acute strep pharyngitis • 2 ry prophylaxis • previous documented RF or those w RHD specifically MS • GAS prevention & new rheumatic episodes • Benzathine PCN im Q 21 days efficacious but painful • Alt PCN V, azithro

RF – duration of chemoprophylaxis • NO rheumatic carditis Ø 5 yrs after acute RF or until age 21 - whichever longer J Am Coll Cardiol 63: e 57, 2014

RF – duration of chemoprophylaxis • Carditis without residual heart disease -> Ø 10 yrs after acute RF or till age 21 - whichever longer J Am Coll Cardiol 63: e 57, 2014

RF – duration of chemoprophylaxis • Carditis w residual heart disease Ø 10 yrs since last episode or till age 40 - whichever longer J Am Coll Cardiol 63: e 57, 2014

RF prevention

Λειτουργία σπλήνα-heterotaxy PCV vaccination, Abx – 5 yrs of age • Abdominal U/S, CT, MRI • Blood smear for Howell-Jolly • RBCs quantification by interference contrast microscopy • Heat damaged Tc-99 labelled RBC scan

Howell-Jolly

Hand hygiene-WHO 5 moments

HAI - AMR

CLABSI prevention • 4 κύριες οδοί • Skin colonization • Intraluminal or hub • 2 ry seeding from BSI • Contaminated infusate CID 2002; 34: 1232 -1242

CLABSI bundle, checklists

Prediction of degree of benefit from ICD implantation Balance of Risk vs benefit Sudden Death from Ventricular Arrhythmia • Non-Sudden Death • Procedural Risk • Inappropriate shocks • Device infection DOI: http: //dx. doi. org/10. 1016/j. cjca. 2016. 09. 009 Copyright © 2016, Canadian Cardiovascular Society

CCS 2016

Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest Resuscitation. 2017 Feb; 111: 103 -109.

Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest • 28% aspiration • No difference in outcome • postresuscitation pneumonia, ICU treatment and outcome Resuscitation. 2017 Feb; 111: 103 -109.