Infective endocarditis

Box 1

Patients at highest risk for a complicated or lethal course of infective

endocarditis (from [2], without modification)

Patients with a valvular prosthesis (mechanical or biological):

Patients with reconstructed valves containing alloprosthetic material in the first

6 months after surgery1,2

Patients who have previously had endocarditis

Patients with congenital heart defects:

Cyanotic heart defects that have not been surgically corrected, or that have
been treated palliatively with the creation of a systemic-to-pulmonary shunt

Heart defects that have been treated surgically with the implantation of
conduits (with or without valves), or residual defects, i.e., turbulent blood flow in
the area of the prosthetic material

All heart defects that have been treated surgically or interventionally, in the
first six months after the procedure2

Heart-transplant recipients who have developed a cardiac valvulopathy

1The DGK/PEG position paper differs on this point from the AHA guidelines.

2After 6 months, adequate endothelialization of prostheses is assumed to have

occurred.

Box 2

Procedures after which antibiotic prophylaxis is recommended for patients who

are at high risk for a complicated or lethal course of infective endocarditis (from
[2])

Dental procedures involving manipulation of the gingiva or the periapical region

of the teeth, or perforation of the oral mucosa

Dental procedures with intraligamentous anesthesia

Procedures in which the mucosa of the upper respiratory tract is incised, e.g.,
tonsillectomy and adenectomy

Procedures after which no antibiotic prophylaxis is recommended

Procedures on the skin and soft tissues

Procedures on the gastrointestinal tract, including gastroscopy and colonoscopy

with biopsy

Procedures on the urogenital tract, including cystoscopy

In general, the following considerations hold: In any procedure involving infected

tissue, the infection should be treated. For patients at high risk for a complicated
or lethal course of infective endocarditis, the prophylactic antibiotic regimen
should be chosen to cover the typical infectious pathogens arising from the site
in question (e.g., gastrointestinal tract: enterococci).