Infective endocarditis

Can infective endocarditis, even when it is recurrent, be prevented?

Not all cases of infective endocarditis (IE) can be prevented, because it is difficult to always know know when bacteremia (bacteria in the bloodstream) occurs. IE is uncommon, but people with some heart defects have a greater risk of developing it. For most individuals, preventing IE involves maintaining good dental hygiene. Brushing, flossing, and visiting a dentist regularly helps prevent tooth and gum infections that could lead to endocarditis. In the past, individuals with nearly every type of congenital heart defect needed to receive antibiotics one hour before dental procedures or operations on the mouth, throat, gastrointestinal, genital, or urinary tract. However, the American Heart Association later simplified its recommendation. Today, antibiotics are typically only recommended for individuals with the highest risk of IE, those who have:

  • An artificial heart valve or who have had a heart valve repaired with artificial material
  • A history of endocarditis
  • A heart transplant with abnormal heart valve function
  • Certain congenital heart defects including:
    • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits
    • A congenital heart defect that's been completely repaired with artificial material or a device for the first six months after the repair procedure
    • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device

Some congenital heart defects can be successfully repaired surgically and the person will no longer be at risk for endocarditis. Examples include:

  • Ventricular septal defect — The opening between the heart’s two lower chambers can be closed.
  • Atrial septal defect — The opening between the heart’s two upper chambers can be closed.
  • Patent ductus arteriosus — The open passageway between the artery to the lungs and the large artery that takes blood from the heart to the body is closed.

After the defects are completely repaired surgically, there is no longer an increased risk for endocarditis in these individuals.

People who have had endocarditis before are at high risk of getting it again. This is true even when they don’t have heart disease. Recurrent endocarditis is defined as repeated episodes of infection separated by intervals of at least 6 months or caused by different microorganisms. The number of individuals with recurrent IE is increasing as a result of improved treatment. It has been found that underlying abnormalities in cardiac structure and active intravenous drug abuse are associated with increased risk of recurrent IE. It has been proposed that failure to destroy a local area of bacteria may be responsible for recurrent IE caused by the same microorganism. Prolonged survival of individuals with recurrent IE is generally attributable to intense workups and early antimicrobial treatment, as well as prompt surgical intervention.

Last updated on 05-01-20

Name: Infectious Diseases Society of America 1300 Wilson Blvd Suite 300
Arlington, VA, 22209, United States
Phone: +1-703-299-0200 Fax : +1-703-299-0204 Email: https://www.idsociety.org/contact-us/ Url: https://www.idsociety.org/
Name: National Foundation for Infectious Diseases 7201 Wisconsin Avenue Suite 750
Bethesda, MD, 20814, United States
Phone: +1-301-656-0003 Fax : +1-301-907-0878 Email: http://www.nfid.org/contact Url: http://www.nfid.org
Name: International Society for Infectious Diseases 9 Babcock Street, 3rd Floor
Brookline, MA, 02446 , United States
Phone: +1- 617-277-0551 Fax : +1-617-278-9113 Email: info@isid.org Url: http://www.isid.org
Name: American Heart Association 7272 Greenville Avenue
Dallas, TX, 75231-4596, United States
Phone: 214-570-5978 Toll Free: 800-242-8721 Email: https://www.heart.org/en/forms/general-questions-and-latest-research-information Url: https://www.heart.org

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