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MINISTERUL S ĂNĂTĂŢ II AL REPUBLICII MOLDOVA Endocardita infec ţ ioas ă la adult Protocol

MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA

Endocardita infecţioasă la adult

Protocol clinic naţional

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PCN-80

Chişinău, 2014

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Aprobat la şedinţa Consiliului de experţi al Ministerului Sănătăţii al Republicii Moldova din18.06.2014, proces verbal nr.3

Aprobat prin ordinul Ministerului Sănătăţii al Republicii Moldova nr. 544 din 20.06.2014 „Cu privire la actualizara unor Protocoale clinice naţionale”

Eleonora Vataman

Ana Ştirbul Gheorghe Manolache

Minodora Mazur

Alexandra Grejdieru

Aurel Grosu

Uliana Jalbă, Tatiana Colesnic

Victor Ghicavði

Grigore Bivol

Elaborat de colectivul de autori:

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a+e+ş+j+)molcbplorkfsbopfq^o)`^qbao^Ybaf`fkăUkqbokăko+0)RPYC

‚Kf`li^bQbpqbjfţ^kr’

a+ş+j+)`lkcbobkţf^orkfsbopfq^o)`^qbao^Ybaf`fkăUkqbokăko+0)RPYC

‚Kf`li^bQbpqbjfţ^kr’+

a+e+ş+j+)molcbplorkfsbopfq^o)şbcAbm^oq^jbkqRodbkţb@^oaf^`b)

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a+ş+j+)`lkcbobkţf^orkfsbopfq^oUYPM)Ukpqfqrqriab@^oaflildfb

^pfpqbkqăjbaf`^iămofk`fm^iăfkqbofj^oă)UYPM)Ukpqfqrqriab

@^oaflildfb

Recenzenţi oficiali:

a+e+ş+j+)molcbplorkfsbopfq^o) şbc`^qbaoăc^oj^`lildfbşfc^oj^`lildfb`ifkf`ă) RPYC‚Kf`li^bQbpqbjfţ^kr

a+ș+j+)molcbplorkfsbopfq^o) şbc`^qbaoăjbaf`fk^abc^jfifb)RPYC‚Kf`li^b Qbpqbjfţ^kr’

Valentin Gudumac

a+e+ş+j+)molcbplorkfsbopfq^o) şbc`^qbaoăjbaf`fk^abi^_lo^qlo)RPYC‚Kf`li^b Qbpqbjfţ^kr’

Alexandru Coman

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Maria Cumpănă

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Iurie Osoianu

sf`bafob`qlo)@ljm^kf^K^ţflk^iăab>pfdroăofékYbaf`fkă

ĜĊ

CUPRINS

A.

PARTEA INTRODUCTIVĂ

4

>+.+Af^dklwăFBkal`^oafq^fkcb`ţfl^păi^^ariq+

1

>+/+@lari_liff4@UY.-5FU@A”-00

A

>+0+Rqfifw^qloff

A

>+1+P`lmrofibmolql`lirirf

A

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A

>+B+A^q^^`qr^ifwăoffFf^kr^ofb/-.1

A

>+C+Xfpq^şffkcloj^ţffibab`lkq^`q^ib^rqlofiloşf^ibmbopl^kbilo`b^rm^oqf`fm^qi^bi^_lo^ob^

 

molql`lirirf

A

>+D+Abcfkfţffibşf`i^pfcf`ăofibclilpfqbékal`rjbkq

B

>+E+Ukcloj^ţfbbmfabjflildf`ă

C

B.

PARTEA GENERALĂ

8

?+.+Kfsbiab^pfpqbkţăjbaf`^iămofj^oă

D

?+/+Kfsbiab^pfpqbkţăpmb`f^ifw^qăab^j_ri^qlo

E

?+0+Kfsbiab^pfpqbkţăjbaf`^iăpmfq^if`b^p`ă

.-

C.1. ALGORITMI DE CONDUITĂ

13

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@+/+/+0+Bu^jbkri`ifkf`++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++.D

@+/+/+1+Uksbpqfd^ţffm^o^`ifkf`b++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++.D

@+/+/+1+.+Uksbpqfd^ţffob`lj^ka^_fibl_ifd^qloff)`lkcloj`ofqboffiloabaf^dklpqf`^BU++.E

@+/+/+1+/+Uksbpqfd^ţffabi^_lo^qloşfm^o^`ifkf`baborqfkă++++++++++++++++++++++++++++++++++++++++++++++//

@+/+/+1+0+Uksbpqfd^ţff`ljmibjbkq^ob4i^fkaf`^ţff5++++++++++++++++++++++++++++++++++++++++++++++++++++++++++/0

@+/+/+A+Qo^q^jbkqrim^`fbkţfilo`rBU++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++/0

@+/+/+A+.+Qo^q^jbkqri^kqf_^`qbof^k+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++/0

C.2. DESCRIEREA METODELOR, TEHNICILOR ŞI A PROCEDURILOR

@+/+/+B+@ljmif`^ţffibBU4pr_fb`qrimolql`l^ibilopbm^o^qb5

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D.

RESURSELE UMANE ŞI MATERIALELE NECESARE PENTRU RESPECTAREA

PREVEDERILOR PROTOCOLULUI

30

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0.

 

E.

INDICATORII DE MONITORIZARE A IMPLEMENTĂRII PROTOCOLULUI

33

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BIBLIOGRAFIE

38

 

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ABREVIERILE FOLOSITE ÐN DOCUMENT

AB

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ADN

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CCA

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CMI

`lk`bkqo^ţf^jfkfjăfkef_fqlofb

EI

bkal`^oafqăfkcb`ţfl^pă

EIHN

bkal`^oafqăfkcb`ţfl^pă`rebjl`riqrofkbd^qfsb

EIVP

bkal`^oafqăfkcb`ţfl^pă^s^isbfmolqbw^qb

EIVN

bkal`^oafqăfkcb`ţfl^pă^s^isbilok^qfsb

ETE

b`l`^oafldo^cfbqo^kpbplc^df^kă

ETT

b`l`^oafldo^cfbqo^kpqlo^`f`ă

HACEK

T^bjlmefirppmm+)>`qfkl_^`fiirp^`qfkljv`bqbj`ljfq^kp)

@^oafl_^`qbofrjeljfkfp)Bfhbkbii^`loolabkp)Wfkdbii^hfkd^b

OMS

Lod^kfw^ţf^Ylkaf^iă^Pănătăţff

PCN

Molql`li`ifkf`k^ţflk^i

RPL

ob^`ţf^abmlifjbofw^obéki^kţ

SAMR

Pq^mevil`l``rp^robrpjbqf`fifkl*obwfpqbkq

SAMS

Pq^mevil`l``rp^robrpjbqf`fifkl*pbkpf_fi

VS

sbkqof`ripqÝkd

VD

sbkqof`riaobmq

VG

Sbdbq^ţff

UDIV

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PREFAŢĂ

>`bpqmolql`li^clpqbi^_lo^qabdormriabir`or^iYfkfpqborirfPănătăţffafkObmr_if`^ Ylials^4YPOY5)fkpqfqrfqafkobmobwbkq^kţffUYPM)Ukpqfqrqriab@^oaflildfb şf@^qbao^ Ybaf`fkăUkqbokăko+0^RkfsbopfqăţffabPq^qabYbaf`fkă şfC^oj^`fb‚K+Qbpqbjfţ^kr’+ Molql`lirik^ţflk^ibpqbbi^_lo^qék`lkclojfq^qb`rdefarofibfkqbok^ţflk^ib^`qr^ib

mofsfkabkal`^oafq^fkcb`ţfl^păi^mbopl^kbib^ariqb şfml^qbpbosfaobmq_^wămbkqorbi^_lo^ob^ molql`l^ibilofkpqfqrţflk^ib)obfbşfkaafkmlpf_fifqăţfibob^ib^ibcfb`ăobffkpqfqrţffék^kri`robkq+

A. PARTEA INTRODUCTIVĂ

A.1. Diagnoză: Endocardita infecţioasă la adult.

Af^dklpqf`ris^fk`irabfkcloj^ţf^abpmobF^`qfsfq^qb^mol`bprirf)ob`robkţ^)pq^qrqriaf^dklpqf`)

m^qldbkf^)il`^ifw^ob^^k^qljf`ă şf^dbkqrim^qldbk+ Exemple de diagnostic clinic:

·

Bkal`^oafqăfkcb`ţfl^păclojă^`qfsă)`^rw^qăabPqobmql`l``rpsfofa^kp+@^oaflm^qfb obrj^qfpj^iă+Pqbklwăjfqo^iăjlabo^qă+Ukprcf`fbkţ^abs^isăjfqo^iădo+UUU+Ukprcf`fbkţ^ab s^isăqof`rpmfaădo+UUU+Cf_ofi^ţfb^qof^iă`olkf`ă+U@UUUKeT>+@^ofbpabkq^ojriqfmir) m^o^alkqfqă+

·

Bkal`^oafqăfkcb`ţfl^păklwl`ljf^iăabs^isăjfqo^iă)clojă^`qfsă)`^rw^qăabBkqbol`l``rp c^b`^ifp+ Ukprcf`fbkţă ab s^isă jfqo^iă do+UUU+ U@ UU KeT>+ Pq^ob armă molpq^qb`qljfb

qo^kprobqo^iă4./+-.+-E5

·

Bkal`^oafqăfkcb`ţfl^pă)ob`robkqă4^iUU *ib^ bmfpla5abs^isă^loq^iămolqbw^qă4-A+/--A5 `^rw^qăabPq^mevil`l``rpbmfabojfafp+Abefp`bkţăabmolqbwă+Ukprcf`fbkţăabs^isă^loq^iă molqbw^qădo+UUU+U@UUUKeT>+

·

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abPq^mevil`l``rp^robrp+Ukprcf`fbkţăabs^isăqof`rpmfaădo+US+U@UUUKeT>+Mkbrjlkfb

pbmqf`ă_fi^qbo^iă)jriqfcl`^iă)`rafpqor`ţfb+Rqfifw^qloabaoldroffkqo^sbklp+

ĞĊ

· Bkal`^oafqăfkcb`ţfl^păclojă^`qfsă`rebjl`riqrofkbd^qfsb)ob`ăabob+@^oaflm^qfb `lkdbkfq^iă+S^isă^loqf`ă_f`rpmfaă+Ukprcf`fbkţ^abs^isă^loq^iădo+UU+>_`bpjfl`^oaf` m^o^fkbi^o+U@UUKeT>+>``fabkq`bob_ols^p`ri^o^`rqék^oqbo^`bob_o^ifpjbaf^mbpqÝkd^

afk.1+-0+-E`rebjfm^obwărşl^oămbaob^mq^+

· Bkal`^oafq^fkcb`ţfl^pă^s^isbfjfqo^ibmolqbw^qb)q^oafsă4/--C5)`rebjl`riqrofkbd^qfsb+U@

UKeT>+

A.2. Codul bolii (CIM 10): ICD – 033

Ċ

A.3. Utilizatorii

· Lcf`ffibjbaf`filoabc^jfifb4jbaf`fabc^jfifbşf^pfpqbkqbibjbaf`^ibabc^jfifb5

· @bkqobibabpănăq^qb4jbaf`fabc^jfifbşf^pfpqbkqbibjbaf`^ibabc^jfifb5

· >pl`f^ţffibjbaf`^ibqbofqlof^ib4jbaf`fabc^jfifbşf`^oaflildf5

· Ukpqfqrţffib,pb`ţffib`lkpriq^qfsb4`^oaflildf5

· Pb`ţffibabqbo^mfb^ibpmfq^ibiloo^flk^ib)jrkf`fm^ibşfobmr_if`^kb4jbaf`f_liffkqbokb5

· Pb`ţffibab`^oaflildfb^ibpmfq^ibilojrkf`fm^ibşfobmr_if`^kb4`^oaflildf5

KlqăFMolql`lirii^kb`bpfq^qbml^qbcfrqfifw^qab^iţfpmb`f^ifşqf+

A.4. Scopurile protocolului .+@obşqbob^krjăoriabm^`fbkţf`^ob_bkbcf`f^wăabaf^dklpqf``lob`qmob`l`b şfpmfq^ifw^obék qbojbklmloqrkmbkqor^mif`^ob^qo^q^jbkqrirfob`lj^ka^qabjbaf`fk^_^w^qămbalsbwfG /+Éj_rkătăţfob^`^ifqăţffbu^jfkăoff`ifkf`bşfm^o^`ifkf`b ^m^`fbkţfilo`rBUG

0+Bq^mfw^ob^af^dklpqf`rirfşfqo^q^jbkqrirfBUi^afcbofqbsbofdf^ib^pfpqbkţbfjbaf`^ibG

1+Pbkpf_fifw^ob^jbaf`filoafkfkpqfqrţffibabjbaf`fkămofj^oă şfabpq^ţflk^o şf^m^`fbkţfiloék `rkl^şqbob^fkaf`^ţffiloşf^mif`^ob^jăprofiloabmolcfi^ufb^BUG

A. 5. Data elaborării protocolului: 2012

A. 6. Data actualizării: 2016

A.7. Lista şi informaţiile de contact ale autorilor şi ale persoanelor ce au participat la elaborarea protocolului

Numele

Funcţia

Ao+Biblklo^S^q^j^k)al`qlo

ŞbcAbm^oq^jbkqUkprcf`fbkţă@^oaf^`ă)UYPMUkpqfqrqriab

e^_fifq^qékjbaf`fkă)molcbplo

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rkfsbopfq^o

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Ao+>k^Şqfo_ri

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şqffkţbjbaf`^ib)`bo`bqăqlo

@ifkf`Obmr_if`^k

şqffkţfcf`prmboflo

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ğĊ

Protocolul a fost discutat, aprobat şi contrasemnat:

Denumirea

Numele şi semnătura

>pl`f^ţf^Ybaf`filoabC^jfifbafkOY

>pl`f^ ţ f^Ybaf`filoabC^jfifbafkOY

@ljfpf^şqffkţfcf`l*jbqlaf`ăabmolcfi‚M^qlildfb `^oafls^p`ri^oă şfobrj^qlildfb’

@ljfpf^ ş qffk ţ fcf`l*jbqlaf` ă abmolcfi‚M^qlildfb `^oafls^p`ri^o ă ş fobrj^qlildfb’

Pl`fbq^qb^UkqbokfşqfiloafkOY

Pl`fbq^qb^Ukqbokf ş qfiloafkOY

@lkpfifriabBumboţf^iYfkfpqborirfPănătăţff

@lkpfifriabBumbo ţ f^iYfkfpqborirfP ănătăţ ff

>dbkţf^Ybaf`^jbkqrirf

>dbk ţ f^Ybaf`^jbkqrirf

@ljm^kf^K^ţflk^iăab>pfdroăofékYbaf`fkă

@ljm^kf^K^ ţ flk^i ă ab>pfdro ă ofékYbaf`fk ă

@lkpfifriK^ţflk^iabBs^ir^obşf>`obafq^obékPănăq^qb

@lkpfifriK^ ţ flk^iabBs^ir^ob ş f>`obafq^obékP ănă q^qb

A.8. Definiţiile şi clasificările folosite ðn document Endocardită infecţioasă: Ukcb`ţfbjf`ol_f^kăbkals^p`ri^oă^pqor`qrofilo`^oafls^p`ri^ob4s^isb

k^qfsb)bkal`^oasbkqof`ri^op^r^qof^i5)fk`irpfsbka^oqboffq^s^pbilofkqo^qlo^`f`bj^of4ék`^k^i

^oqbof^im^qbkq)ék şrkqrof^oqbofl*sbkl^pb)ék`l^o`q^ţfbab^loqă5)p^r^`lomfilofkqo^`^oaf^`f

pqoăfkf4s^isbmolpqbqf`b)m^`bj^hbop^rabcf_ofi^qlofkqo^`^oaf^`5)fkcb`ţfbobibs^qăékciruri

p^kdrfk`rrkmolklpqf`molpqşfljloq^ifq^qbék^iqă+ I.Endocardita infecţioasă ðn funcţie de criteriile de diagnostic. Endocardită infecţioasă se consideră definităa^`ăékqfjmrirkbfpbmqf`bjffp^rfkcb`ţff

pfpqbjf`bbpqbabjlkpqo^qăfjmif`^ob^bkal`^oarirf4mobcbobkţf^imofk`bo`bq^ob^B`l@S

qo^kpbplc^df^kă5G

Endocardită infecţioasă pb`lkpfaboă definitămicrobiologic pozitivă^qrk`f`Ýkabpqbalsbafqă prmifjbkq^oşf_^`qbofbjf^mofk/ebjl`riqrofmlwfqfsb`rékpăjÝkţ^ob^^`birf^şf^dbkqm^qldbk

p^rmofkmobwbkţ^>AK_^`qbof^k4^`fariabwlufof_lkr`ibfkf`5G

Endocardită infecţioasă definită microbiologic negativă 4cu hemoculturi negative5BUTK: pb `lkpfaboă)^qrk`f`Ýka_^`qbofbjf^krbpqbalsbafqă)a^obpqbabjlkpqo^qăfjmif`^ob^ bkal`^oarirfG Endocardita infecţiosă suspectă pbpq^_fibşqb`Ýkabufpqărkdo^aék^iqabprpmf`frkb`ifkf`ă mbkqorBU)a^ofjmif`^ob^bkal`^oarirfkrbpqbalsbafqăi^jljbkqri`bo`bqăoff+ Endocardita infecţiosă posibilăbpqbkrj^frkaf^dklpqf`afcbobkţf^imlqbkţf^i)i^m^`fbkţffcb_ofif+

>`b^pq^bpqbpfqr^ţf^`Ýka^mif`^ob^`ofqboffiloabaf^dklpqf`mbkqorBU)ARWB)obsăwrqbék.EE1

4q^_biriA5^rlfjmloq^kţăablpb_fqăG

II.Endocardita infecţioasă ðn funcţie de localizarea infecţiei şi prezenţa sau absenţa materialelor intracardiace. 1.Endocardita infecţiosă pe valvă nativă a cordului stäng: lfkcb`ţfbbkals^p`ri^oă^`loarirf `r^cb`q^ob^s^isbilojfqo^ibşf,p^rs^isbilo^loq^ibG 2.Endocardită infecşioasă de proteză a cordului stäng:

Ċ

ĠĊ

· Endocardita infecţiosă a valvei protezate (EIVP) timpurie: fkcb`q^ob^molqbwbfs^isri^ob mÝkăi^rk^karmă`eforodf^s^isbfG

· Endocardita infecţiosă a valvei protezate (EIVP) tardivă: fkcb`q^ob^ molqbwbfs^isri^ob

mbpqbrk^karmă`eforodf^s^isbfG 3.Endocardita infecţiosă de cord dreptFlfkcb`ţfbbkals^p`ri^oă^`loarirf`r^cb`q^ob^fwli^qă^ s^isbfqof`rpmfabp^r,şfs^isbf^oqbobfmrijlk^obG 4.Endocardita infecţioasă legată de dispozitive intracardiace: BU ^măorqă i^ m^`fbkţff `r pqfjri^qlo`^oaf^`p^rabcf_ofi^qlo`^oaf^`fjmi^kq^_fi+ I.Endocardita infecţioasă ðn funcţie de modalitatea de apariţie:

1.EI legată de ðngrijirea medicală a pacientului A.Endocardita nozocomială: BU ^măorqăi^rkm^`fbkqpmfq^ifw^q;1Dlob^kqboflo fkpq^iăoffpbjkbiloşfpfjmqljbiloabBU+ Endocardita non-nozocomială: Pbjkbib şf ,p^r pfjmqljbib ab BU ^măorqb 9 1D lob ab i^ ^ajfqbob^m^`fbkqrirf`^ob^mofjfqékdofgfofjbaf`^ibabqfmriF .+Ékdofgfobjbaf`^iăi^aljf`fifr)qbo^mfbfkqo^sbkl^pă)ebjlaf^ifwăp^r`efjflqbo^mfb

fkqo^sbkl^pă90-abwfibék^fkqb^^m^ofţfbfBU+

/+Pmfq^ifw^obékqo*lrkfq^qbabrodbkţă9E-abwfib^kqboflofkpq^iăoffBU+

0+Mbopl^kb^ci^qbék^wfirofp^r`bkqobabékdofgfobmbqbojbkirkd+

B.Endocardită infecţioasă comunitară:Pbjkbibşf,p^rpfjmqljbibabBU^măorqb91Dlob armăpmfq^ifw^obi^rkm^`fbkq`^obkrékabmifkbşqb`ofqboffibrkbffkcb`ţffibd^qbabékdofgfob^ jbaf`^iă+ C.Endocardita infecţiosă legată de consumul de droguri intravenoase: BU^măorqăi^rqfifw^qloff

abaoldroffkqo^sbklp4RAUS5cără^iqăpropăabfkcb`ţfb+

Endocardita infecţioasă activă:

· BU`rcb_oămbopfpqbkqă şfebjl`riqrofmlwfqfsbp^r

· jloclildfbfkci^j^qlofb^`qfsădăpfqăi^`eforodfb

· p^rm^`fbkq^ci^qék`ăpr_qo^q^jbkqq^kqf_flqf`p^r

· efpqlm^qlildfbbsfabkqăabBU^`qfsăG

Endocardita infecţiosă bpqb`lkpfabo^qăvindecată ^qrk`f`Ýkap*^molarpfo^af`^ob^ abcfkfqfsă^fkcb`ţfbf şf m^`fbkqri^obqbjmbo^qroă`lomlo^iăkloj^iă)SPTékifjfqbkloj^ib şf ebjl`riqrofkbd^qfsbékab`ropab.^karmăcfkfp^ob^`robfabqo^q^jbkq+

Endocardita infecţiosă recurentă:

· recădereFobmbq^ob^bmfplarirfabBU`r^`bi^şfjf`ollod^kfpj9Birkfabi^bmfplari

fkfţf^i+

· reinfectare: fkcb`ţfb`rrkjf`ollod^kfpjafcbofqp^robmbq^ob^bmfplarirfabBU`r^`bi^şf jf`ollod^kfpj;Birkfabi^bmfplarifkfţf^i+

A. 9. Informaţie epidemiologică Ékmlcfa^qrqrolomoldobpbiloékobdfpqo^qbékaljbkfrim^qlildffilo`^oafls^p`ri^ob şf _lifilofkcb`ţfl^pb)bkal`^oafq^fkcb`ţfl^păoăjÝkblclojăpbsboăab^cb`q^obs^isri^oă^pl`f^qă `rrkmolklpqf`molpq şfljloq^ifq^qbék^iqă)abşf^qÝqjbqlabibabaf^dklpqf`)`Ýq şfmol`barofib qbo^mbrqf`b ^r ^s^kp^q g.)/)1i+ BU bpqb l ^cb`ţfrkb o^oă) ^qfkdÝka l fk`fabkţă 0 ” .- bmfpl^ab ,

.-----mbopl^kbmb^kg.)0i+A^`ăfkfţf^i^clpq`lkpfabo^qăl^cb`ţfrkb^^ariqrirfqÝkăo`r_l^iă

s^isri^oămobbufpqbkqă4j^fcob`sbkqmlpqobrj^qfpj^iă5)^`rjbpqbékqÝikfqă şfi^m^`fbkţff sÝopqkf`fg )./i+P*^rbsfabkţf^qklfc^`qlofmobafpmlw^kţfFmolqbwăs^isri^oă)p`ibolwăs^isri^oă abdbkbo^qfsă)rqfifw^ob^abaoldroffkqo^sbklp)`obşqbob^rqfifwăoffmol`barofilofks^wfsb`rofp`ab _^`qbofbjfbgA)E) i+BUkbqo^q^qăbpqbl^cb`ţfrkbc^q^iă+Ék`^w`Ýkaaf^dklpqf`ripbpq^_fibşqb`r ékqÝowfbobp^rjăprofibqbo^mbrqf`bkb`bp^obprkqqbjmlofw^qb)fkaf`bibjloq^ifqăţffpbjbkţfkbi^

rkkfsbiék^iqF.B”/-1mbkqorBU`ljrkfq^obşf/1”A-1mbkqorBUklwl`ljf^ibgA)B)Ci+

Ċ

ġĊ

B. PARTEA GENERALĂ

Ċ

B.1. Nivel de asistenţă medicală primară

 

Descriere (măsuri)

Motive (repere)

 

Paşi (modalităţi şi condiţii de realizare)

 

I

II

 

III

Molqb`ţf^mboplk^irirf

Molqbg^ob^ab`lkq^`qri`r

 

Obligatoriu:

if`efabib_flildf`b)ab

Molqb`ţf^mboplk^irirfmofkrqfifw^ob^

^oqf`libiloabmolqb`ţfb4jăkrşf)e^i^qb5

 

bumrkbobi^^dbkţffkcb`ţflşfşf

qluf`fpbbcb`qrb^wăékqfjmri

bu^jbkrirf`ifkf`^im^`fbkqri+

 

1. Profilaxia EI

Uabkqfcf`^ob^m^`fbkţfilo`r

 

Obligatoriu:

C.2.2.1

c^`qlofabofp`mbkqorBUék

.+Bsfabkţ^m^`fbţfilo`rj^i^aff`^oaf^`b `rofp`ék^iq mbkqorabwsliq^ob^BU (Tabelul 1)G

p`lmrimobsbkfoffabwsliqăoff

^`bpqbfj^i^aff+

/+>qbkţflk^ob^c^ţăabmol`barofib`^ob fjmrkmolcfi^uf^BU(Tabelul 2)

0+>ibdbob^

molql`l^ibilo

molcfi^`qf`b

(Tabelul 4)

1+Ukcloj^ob^

m^`fbkqrirf

ék

`bb^

`b

mofsbpqb

ofp`ri

fkafsfar^i

mbkqor

abwsliq^ob^BUşffkpqorfob^irféksbabob^

bcb`qr^off

jăprofilo

ab

molcfi^ufb

4fk`irpfsmolcfi^uf^^kqf_^`qbof^kă5+

 

Crokfw^ob^defarirfmbkqorm^`fbkq)`^ob

fkaf`ăqfmriibwfrkff`^oaf^`b)ofp`rimbkqor

BUşfjăprofibabmobsbkţfb

 

(Anexa 1,2,3)

2. Diagnosticul

/+.+Bu^jbkrimofj^o

Af^dklpqf`^ob^mob`l`b^

 

Obligatoriu:

C.2.2.2

m^`fbkţfilo`rBUmbojfqb

.+>k^jkbw^(Caseta 2) /+Bu^jbkri`ifkf`(Caseta 4)

 

C.2.2.3

^pfdro^ob^^pfpqbkţbfjbaf`^ib

`lobpmrkw^ql^ob`b`lkqof_rfb

 

i^obar`bob^jloq^ifqăţffşf^

`ljmif`^ţffilo

/+/+Bu^jfkăofibm^o^`ifkf`b

Mbkqorpq^_fifob^af^dklpqf`rirf

 

Obligatoriu:

C.2.2.4.1

mobwrjmqfs

.+ >k^ifw^dbkbo^iă^pékdbirf(Caseta 6)

 

C.2.2.4.2.

/+ >k^ifw^dbkbo^iă^rofkbf(Caseta 6) 0+ B@S(Caseta 7)

 

Qlţfm^`fbkţff`rprpmf`frkbabBUqob_rfb

Ċ

ĢĊ

afob`ţflk^ţfmbkqor`bo`bq^ob^B`l@Sék mofjbibC”./lob+(Tabelul 7; Algoritmul 1) 3. Tratamentul
afob`ţflk^ţfmbkqor`bo`bq^ob^B`l@Sék
mofjbibC”./lob+(Tabelul 7; Algoritmul
1)
3. Tratamentul
Qo^q^jbkqrikrpbbcb`qrb^wă
Qo^kpmloq^ob^m^`fbkqrirfi^
Obligatoriu:
ék`lkafţffab^j_ri^qlo
bq^m^abpq^ţflk^o
.+@lkpriq^ţf^`^oaflildrirf+
/+Qlţfm^`fbkţff`rprpmf`frkbabBU
kb`bpfqăfkqbok^obékpb`ţffibo^flk^ib)
jrkf`fm^ibp^robmr_if`^kb`^oblcboă
pbosf`ff`^oaflildf`bp^rqbo^mbrqf`b+
B.2. Nivel de asistenţă specializată de ambulator
Descriere (măsuri)
Motive (repere)
Paşi (modalităţi şi condiţii de realizare)
I
II
III
Molqb`ţf^mboplk^irirf
Molqbg^ob^ab`lkq^`qri`r
Obligatoriu:
if`efabib_flildf`b)abbumrkbob^
Molqb`ţf^
mboplk^irirf
mofk
rqfifw^ob^
i^^dbkţffkcb`ţflşfşfqluf`fpb
^oqf`libiloabmolqb`ţfb4jăkrşf)e^i^qb5
bcb`qrb^wăékqfjmribu^jbkrirf
`ifkf`^im^`fbkqri+
1.Diagnosticul
.+.+ Bu^jbkrimofj^o
Af^dklpqf`^ob^mob`l`b^BU
Obligatoriu:
C.2.2.2
mbojfqb^`loa^ob^^pfpqbkţbf
·
.+>k^jkbw^(Caseta 2)
C.2.2.3
jbaf`^ibékslirjabmifk`b
·
/+Bu^jbkri`ifkf`(Caseta 4)
`lkqof_rfbi^obar`bob^
jloq^ifqăţffşf^`ljmif`^ţffilo+
.+/+ Bu^jfkăofib
Mbkqorpq^_fifob^af^dklpqf`rirf
m^o^`ifkf`b
`ifkf`FBUabcfkfqă`r
Ðn suspiciunea clinică pentru EI
este obligatorie :
C.2.2.4.1
jf`ol_flildfbmlwfqfsă
·
C.2.2.4.2
C.2.2.4.3
B`l`^oafldo^cf^BQQp^rBQB/ékmofjbib
C”./lob
(Tabelul 7; Algoritmul 1)
·
Ob`liq^ob^ebjl`riqroff
(Caseta 5, Algoritmul 2);
Obligatoriu:
· M^`fbkq`ifkf`fkpq^_fi”fkqbok^obrodbkqă
ékpq^ţflk^o
· M^`fbkq`ifkf`pq^_fi
ü Uksbpqfd^ţffabi^_lo^qlo(Caseta 6)
ü B@S(Caseta 7)
ü O^afldo^cf^qlo^`birf(Caseta 8)
ü RPSlod^kbilofkqbokb(Caseta 9);
2.Tratamentul
Qo^q^jbkqri
Qo^kpmloq^ob^m^`fbkqrirfi^
Obligatoriu:
kr
pb
bcb`qrb^wă
ék
bq^m^abpmfq^i+
`lkafţffab^j_ri^qlo
.+Qlţfm^`fbkţff`rBUabcfkfqăp^rprpmb`qă
kb`bpfqăfkqbok^obékpq^ţflk^o)ékpb`ţffib
o^flk^ibp^rjrkf`fm^ib)`^oblcboăpbosf`ff
`^oaflildf`bp^rqbo^mbrqf`b+
/+Este necesar transferulfjbaf^q^i
m^`fbkţfiloi^kfsbirifkpqfqrţfbfjbaf`^ib
prmbofl^ob4obmr_if`^kb5ék`^wabF
· Af^dklpqf`ar_flpabBU)afcf`fiabpq^_fifq
ék`lkafţffibfkpqfqrţfbfa^qb
· Mbopfpqbkţ^pfkaoljrirfcb_ofiékmlcfa^
ģĊ
Ċ

qo^q^jbkqrirf^kqf_^`qbof^i^ab`s^q

· BU`ljmif`^qă`rpfkaoljqolj_lbj_lif`) ^cb`q^obobk^iă)^_`bpjfl`^oaf`) fkprcf`fbkţă`^oaf^`ăpbsboă

0+X^^m^ofţf^`ljmif`^ţffilosfq^ib)`^ob

kb`bpfqăqo^q^jbkqpmb`f^ifw^qab^iqmolcfi m^`fbkqriqob_rfbfkqbok^qékpb`ţffpmb`f^ifw^qb

4kbrolildfb)`^oafl`eforodfb)^kdfl`eforodfb)

d^pqol`eforodfb)`eforodfbqlo^`f`i)bq`+5

 

B.3. Nivel de asistenţă medicală spitalicească

 
 

Descriere (măsuri)

Motive (repere)

 

Paşi (modalităţi şi condiţii de realizare)

 

I

II

 

III

Molqb`ţf^mboplk^irirf

Molqbg^ob^ab`lkq^`qri`r

Obligatoriu:

 

if`efabib_flildf`b)abbumrkbob

Molqb`ţf^

mboplk^irirf

mofk

rqfifw^ob^

i^^dbkţffkcb`ţflşfşfqluf`fpb

^oqf`libiloabmolqb`ţfb4jăkrşf)e^i^qb5

bcb`qrb^wăékqfjmribu^jbkrirf

`ifkf`^im^`fbkqri+

 

.+Pmfq^ifw^ob^

@lkafţffib`ifkf`bék`^obbpqb

Criterii de spitalizare:

 

C.2.2.5.

kb`bp^oăpmfq^ifw^ob^m^`fbkqrirf

Secţiile profil terapeutic general, cardiologie (raional, municipal)

 
 

`rBU)fjmif`ăkb`bpfq^qb^

prmo^sbdeboff`ifkf`bpqof`qb)

· Qlţfm^`fbkţff`rBUafcfkfqăp^rprpmb`qă Secţia cardiologie nivel republicanF

bcb`qr^ob^fksbpqfd^ţffilo

m^o^`ifkf`bprmifjbkq^obşf

· Af^dklpqf`ar_flpabBU)afcf`fiabpq^_fq

^ibdbob^qo^q^jbkqrirf+

· Mbopfpqbkţ^pfkaoljrirfcb_ofiékmlcfa^ qo^q^jbkqrirf^kqf_^`qbof^k^ab`s^q

· BU`ljmif`^qă`rpfkaolj qolj_lbj_lif`)^cb`q^obobk^iă)^_`bp jfl`^oaf`)fkprcf`fbkţă`^oaf^`ăpbsboă

· BUi^m^`fbkţf`r`ljlo_fafqăţffjmloq^kqb

 

4af^_bqw^e^o^q)`folwăebm^qf`ă)pqăof`rl

fjrkfq^qb`ljmoljfpă)bq`5

 

Secţia cardiochirurgie nivel republican:

(Tabel 13,14) Secţii de neurologie, angiochirurgie, gastrochirurgie, chirurgie toracică:

· X^^m^ofţf^`ljmif`^ţffilosfq^ib`^ob

 

kb`bpfqăqo^q^jbkqpmb`f^ifw^qabmolcfi+

 

/+Af^dklpqf`ri

 

/+.+Bu^jbkrimofj^o

Af^dklpqf`^ob^mob`l`b^BU

Obligatoriu:

 

C.2.2.2

mbojfqb^`loa^ob^^pfpqbkţbf

.+

>k^jkbw^(Caseta 2) Bu^jbkri`ifkf``rbs^ir^ob^cb_obf) fkaf`filoebjlafk^jf`f+(Casetele 2,3,4)

C.2.2.3

jbaf`^ibékslirjabmifk`b

/+

 

`lkqof_rfbi^obar`bob^

jloq^ifqăţffşf^`ljmif`^ţffilo+

 
 

/+/+Bu^jfkăofib

Mbkqorpq^_fifob^af^dklpqf`rirf

Obligatoriu:

 

m^o^`ifkf`b

`ifkf`

· Ob`liq^ob^ebjl`riqrofilo (Caseta 5, Algoritmul 2);

 

C.2.2.4.1

C.2.2.4.2

· B`l`^oafldo^cf^'abmobcbo^qBQB/ (Tabelul 7; Algoritmul 1)

C.2.2.4.3

 

Obligatoriu:

 

Ċ

ěĚĊ

   

· Uksbpqfd^ţffabi^_lo^qlo(Caseta 6)

· B@S(Caseta 7)

· O^afldo^cf^qlo^`birf(Caseta 8)

Dacă sunt necesare:

fksbpqfd^ţff`ljmifjbkq^obmbkqorbs^ir^ob^ `ljmif`^ţffilo(Caseta 9)

· RPSlod^kbilofkqbokb

· Almmibo^s^pbilo`bob_o^ib)obk^ib)

buqobjfqăţfilo

· @Q)OYK

· @lolk^oldo^cfb

· >loqldo^cfb

· @bo`bq^ob^lcq^ijlildf`ă

3.Tratamentul

0+.+Pqo^qbdf^

Qo^q^jbkqri fkafsfar^ifw^q bpqb ^grpq^qékcrk`ţfbabFaf^dklpqf`ri pq^_fifq şf`ljmif`^ţffGpbml^qb

· M^`fbkţff`rBUslocfprmrşfqbo^mfbf`r ^kqf_flqf`b)abmbkabkqab^dbkqrim^qldbk `^ob^molsl`^qj^i^af^)mlqofsfq pqo^qbdfbf^kqf_^`qbofbkb(Caseta 10, Tabelele 8 – 11)

qbo^mbrqf`ă

ĊC.2.2.5.1.

jlafcf`^

ék

`^wri

pfjmqlj^qlildfbf`lkqfkrfbp^r^

fkcloj^ţffilo

prmifjbkq^ob

· Qo^q^jbkqri`ljmif`^ţffilo`^oaf^`bşf

obwriq^qb

afk

^k^ifwbib

buqo^`^oaf^`b4`lkclojmolql`l^ibilo

_fl`efjf`bp^rafkbu^jfkăofib

pbm^o^qb5

fj^dfpqf`b+

· Qo^q^jbkq`eforodf`^i4`lkcloj

molql`l^ibilopbm^o^qb5

0+/+Qo^q^jbkq

Qo^q^jbkqriob`lj^ka^qab

· Obdfjrofibqbo^mbrqf`békBU`r pqobmql`l`flo^ifşfpqobmql`l`fdormA (Tabelul 8)

`lkpbos^qfs

jbaf`fk^_^w^qămbalsbwf

C.2.2.5.1.

· Obdfjrofibqbo^mbrqf`békBU`r Pq^mevil`l``rppmm+(Tabelul 9)

· Obdfjrofibqbo^mbrqf`békBU`r Bkqbol`l``rppmm.(Tabelul 10)

· Obdfjrofibqbo^mbrqf`bmolmrpbmbkqor qo^q^jbkqrifkfțf^ibjmfof`^iBU (Tabelul 11)

0+0+Qo^q^jbkqri

Ékiăqro^ob^şf`lj_^qbob^

Qo^q^jbkqripbs^bcb`qr^`lkcloj molql`l^ibiloék`^rwă

`ljmif`^ţffilo

mbof`lirirfsfq^i

 

C.2.2.5.1.

 

· Qo^q^jbkqrifkprcf`fbkţbf`^oaf^`b

4`lkclojmolql`lirirfU@5

· Y^k^dbjbkqri`ljmif`^ţffilobj_lif`b (Caseta 11)

· Qo^q^jbkqrifkprcf`fbkţbfobk^ib^`rqb

4`lkclojmolql`l^ibilopbm^o^qb5

0+1+Qo^q^jbkqri

Ukp`lmrimobsbkfoff`ljmif`^ţffilo

· Ukaf`^ţffibmbkqorqo^q^jbkq`eforodf`^i (Tabelul 13,14)

`eforodf`^i C.2.2.5

BU)fk`irpfs^`biloc^q^ib

1+Buqbok^ob^şf

M^`fbkţff`rBUkb`bpfqă

Buqo^priobligatorius^`lkţfkbF

prmo^sbdebob^

prmo^sbdebob^j_ri^qlofbmbkqor

· Af^dklpqf`ribu^`qabq^if^qabpcăşro^q

^j_ri^qlo`r

fabkqfcf`^ob^mob`l`b^

· Obwriq^qbibfksbpqfd^ţffiloşfqo^q^jbkqri

`lkqfkr^ob^

ob`robkţbilop^rob`fafsbiloab

bcb`qr^q

qo^q^jbkqrirfi^

BU+

· Ob`lj^kaăofibbumif`fqbmbkqorm^`fbkq

kb`bpfq^qb

· Ob`lj^kaăofibmbkqorjbaf`riabc^jfifb

Ċ

ěěĊ

Ybaf`riabpb`qlos^bcb`qr^ ObligatoriuF

· Qbojljbqof^

· Tbjldo^j^)rofkldo^j^)M@OG

· T@i^/şf1pămqăjÝkfarmăcfkfp^ob^

qo^q^jbkqrirf

· B`l@Sarmăfkaf`^ţff

NotăFBQB/*b`l`^oafldo^cf^qo^kpbplc^df^kă*i^jljbkqkrbpqbafpmlkf_fiăékObmr_if`^

Ylials^+

Ċ

ěĜĊ

C.1. ALGORITMI DE CONDUITĂ

C.1.1 Algoritmul examenului ecocardiografic (ETT şi ETE) ðn suspiciune de EI

Prpmf`frkb`ifkf`ăabBU

EI  Prpmf`frkb`ifkf` ă abBU

BQQ
BQQ
MolqbwăBQQMlwfqfsăKbd^qfsă
Ċ
Ċ
Ċ
Ċ
s^isri^oăab
Afpmlpfqfspi^_ă
fkqo^`^oaf^``^ifq^qb
Ċ
Prpmf`frkb`ifkf`ăabBU
Ċ
Ċ
Ék^iqăVl^pă
Ċ
Ċ
Ċ
BQB'BQBPqlm
A^`ăBQBfkfţf^iăbpqbkbd^qfsă)a^oprpmf`frkb^oăjÝkb)
Ċ
obmbq^ţfBQBékab`ropabC”.-wfib
 KlqăF'BQBkrbpqbkb`bp^oăékBUfwli^qă^`loarirfaobmqmbs^isăk^qfsă)a^`ăbu^jfk^ob^BQQbpqbab
KlqăF'BQBkrbpqbkb`bp^oăékBUfwli^qă^`loarirfaobmqmbs^isăk^qfsă)a^`ăbu^jfk^ob^BQQbpqbab
_rkă`^ifq^qbşfobwriq^qbibprkq`i^ob+
ěĝĊ
Ċ

C.1.2 Algoritmul diagnosticului microbiologic ðn EI, avänd hemoculturi pozitive sau negative

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ĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊĊQobfmol_bfkabmbkabkqbabebjl`riqroă

fk`r_^qbék`lkafţff^bol_bşf^k^bol_b

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ţ ff^bol_b ş f^k^bol_b  Ċ Ċ Ċ Ċ Ċ

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ţ ff^bol_b ş f^k^bol_b  Ċ Ċ Ċ Ċ Ċ

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@riqrofmlwfqfsb@riqrofkbd^qfsbi^1Dlob

@ifkf`^,B`l@S@ifkf`^,B`l@S

prdbob^wăBU<prdbob^wăBU<

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KrA^A^Kr

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Ék`bmbob^Pbf^ibdăqro^`ri^_lo^qloriabjf`ol_flildfb

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ă qro^`ri^_lo^qloriabjf`ol_flildfb Ċ

qbo^mfbf^kqf_flqf`bPbf^rék`^i`rifksbpqfd^ţffprmifjbkq^ob

^ab`s^qb

Pbqo^qb^wă`^şfBU`r`riqrofkbd^qfsb`rrk obdfj^kqf_flqf`abpmb`qori^odmbkqor^ ^`lmbofjf`ollod^kfpjbibmlpf_fifjmif`^qb

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4a^`ăjf`ollod^kfpjribpqbfabkqfcf`^q)pb

qob`bi^p`ebj^`lob`qăab^kqf_flqf`b5

Bpqbkb`bp^oă`eforodf^<

KrA^

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Obbs^ir^ob^qo^q^jbkqpbqofjfqbs^is^bu`fw^qă,j^qbof^iriObbs^ir^ob^

m^`fbkqrirfjbaf`^jbkqlpbj_lif`mbkqor^k^qljlm^qlildfb)m^`fbkqrirf

şf`lkpfabo^ob^`lilo^ţfbSo^j)`riqro^şfşf`lkpfabo^ob^

rkrfaf^dklpqf``oflmobwbos^obmbkqorrkmlpf_fiM@Orkrfaf^dklpqf`

^cfoj^qfs^cfoj^qfs

'A^`ăjf`ollod^kfpjrioăjÝkbkbfabkqfcf`^q şfm^`fbkqribpqbpq^_fi)pb`lkpfaboălmofob^ ^kqf_flqf`lqbo^mfbfşfobmbq^ob^ebjl`riqrofilo+

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C.2. DESCRIEREA METODELOR, TEHNICILOR ŞI A PROCEDURILOR

C.2.1. Conduita pacientului cu EI

Caseta 1. Paşii obligatorii ðn conduita pacientului cu EI:

· Uksbpqfd^ob^l_ifd^qlofbmofsfkac^`qloffabofp`)`lkafţffib`ifkf`b^pl`f^qb)mol`babbibaf^dklpqf`b şf qbo^mbrqf`bbcb`qr^qbékmob^i^_fi

· Bu^jbkri`ifkf`

· Uksbpqfd^ţffibabi^_lo^qloşfm^o^`ifkf`b

· Bs^ir^ob^armă`ofqboffibabaf^dklpqf`mbkqorBU

· Pmfq^ifw^ob^l_ifd^qlofbmbkqorfkfţfbob^qo^q^jbkqrirf^kqf_^`qbof^kék`lkclojfq^qb`rpbkpf_fifq^qb^i^ ^kqf_flqf`bşfqo^q^jbkqri`ljmif`^ţffiloj^i^afbf

· >i`ăqrfob^mi^krofilofkafsfar^ibab`lkarfqămlpqpmfq^if`b^p`ă şfmolcfi^uf^ob`robkţbiloBU+

C.2.2.1. Factori de risc pentru dezvoltarea endocarditei infecţioase Tabelul 1. Afecţiunile cardiace cu cel mai ðnalt risc de EI, pentru care este recomandată profilaxia cänd sunt efectuate intervenţii cu risc crescut

Recomandări: profilaxie

Clasa

Nivel

Antibioticoprofilaxia trebuie luată ðn considerare doar pentru pacienţii cu risc crescut de EI .+M^`fbkţf`rs^isămolqbqf`ăp^rj^qbof^imolqbqf`rqfifw^qmbkqorobm^o^ob^rkbfs^isb /+M^`fbkţf`rBUék^kqf`babkţă

UU^

@

0+M^`fbkţf`r_lif`^oaf^`b`lkdbkfq^ibF

· ?lif`^oaf^`b`lkdbkfq^ib`f^kldbkbcărăobm^o^ob`eforodf`^iăp^r`rabcb`qb

obwfar^ib)şrkqrofp^r`lkar`qbm^if^qfsb

· ?lif`^oaf^`b`lkdbkfq^ibobm^o^qb`ljmibq`rj^qbof^imolqbqf`cfbmofkfkqbosbkţfb

`eforodf`^iăp^rmofkqbekf`fmbo`rq^kb)mÝkăi^Birkfarmăfkqbosbkţfb+

· @Ýkarkabcb`qobwfar^imbopfpqăi^il`riabfjmi^kq^ob^rkrfj^qbof^imolqbqf`p^r

afpmlwfqfsmofkfkqbosbkţfb`eforodf`^iăp^rqbekf`fmbo`rq^kb

>kqf_flqf`lmolcfi^uf^krj^fbpqbob`lj^ka^qăék^iqbclojbabs^isrilm^qffp^r_lif

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`^oaf^`b`lkdbkfq^ib

Tabelul 2. Recomandări privind profilaxia endocarditei infecţioase la pacienţii cu cel mai ðnalt risc ðn funcţie de tipul procedurii cu risc

Recomandări: profilaxie

Clasa

Nivel

A.Intervenţii stomatologice Profilaxia antibiotică trebuie avută ðn vedere doar pentru:

II a

C

Mol`barofibabkq^ob`^obkb`bpfqăF

· j^kfmri^obdfkdfs^iăp^r

· ^obdfrkffmbof^mf`^ib^afkqbirfp^r

· mboclo^ţff^ibjr`l^pbf_r`^ib

Profilaxia antibiotică nu e recomandată pentru:

III

C

· Ukgb`ţff^kbpqbqf`bil`^ibékţbprqrofkbfkcb`q^qb

· P`l^qbob^prqrofilo

· O^afldo^cffabkq^ob

· Mi^p^ob^p^r^grpq^ob^^m^o^qbilomolpqlalkqf`bp^rloqlmbaf`babq^ş^_fib

· Armăp`l^qbob^afkţfiloqbjmlo^o

· Armăqo^rjb^ib_rwbilop^r^ibjr`l^pbilolo^ib

B.Proceduri la nivelul tractului respirator

   

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ěğĊ

Profilaxia antibiotică nu este recomandată pentru proceduri la nivelul tractului respirator, incluzänd:

III

C

· ?olkelp`lmf^p^ri^ofkdlp`lmf^cără_flmpfb

· Ukqr_^ob^qo^kpk^w^iăp^rlolqo^eb^iă

C.Proceduri ðn sfera gastrointestinală sau urogenitală Profilaxia antibiotică nu este recomandată pentru:

III

C

· S^pqolp`lmfb

· @lilklp`lmfb

· @fpqlp`lmfb

· B`l`^oafldo^cfbqo^kpbplc^df^kă

D.Piele şi ţesuturi moi Profilaxia nu este recomandată pentru nici o procedură

III

C

Notă:.+Udfbk^abkq^oă şf`lkqoliripqlj^qlildf`obdri^qprkqj^ffjmloq^kqbab`Ýqmolcfi^uf^^kqf_flqf`ăék obar`bob^ofp`rirfabBU. /+ profibab^pbmpfbprkql_ifd^qloffékqfjmrij^kfmriăoff`^qbqbofilosbkl^pb şfékqfjmrimol`barofilo fks^wfsbmbkqor^obar`bo^q^BUibd^qăabékdofgfofibjbaf`^ib+

Tabelul 3. Comorbidităţi, factori de risc suplimentari pentru dezvoltarea EI care necesită profilaxie obţională

K,o

C^`qlofabofp`

 

@ljlo_fafqăţf

.+

Săopq^ék^fkq^qă

 

/+

Sbdbq^ţffqolj_lqf`b^_^`qbofbkb

 

0+

>cb`ţfrkffjrkl`ljmoljfpb`refmbo`l^dril_fifq^qb

·

Xbr`bjf^

·

@folw^ebm^qf`ă

·

@^o`fkljebm^qf`

·

>cb`ţfrkffkqbpqfk^ibfkci^j^qloff

·

Xrmrpbofqbj^qlppfpqbjf`

·

Ybaf`^ţfbpqbolfaă

1+

M^qlildf^pfpqbjrirffjrk

·

Abcb`qbrjlo^ib

·

Abcb`qb`biri^ob

A+

@ljmoljfqbob^jb`^kfpjbiloil`^ib

·

Xbwfrkfibjbj_o^kbilojr`l^pb`r

ab^măo^ob

·

@obşqbob^mbojb^_fifqăţff4fkci^j^ţff

·

Ukqbpqfk^ib`olkf`b5

·

@ib^o^k`b*ri`^mfi^oobarp

4cfpqrib^oqbofl*sbkl^pb5

·

Tbjlaf^ifw^`olkf`ă

B+

>cb`ţfrkf`olkf`b_^`qbofbjf`b

·

>cb`ţfrkf`rq^k^qbékaf^_bqw^e^o^q

·

@lj_rpqff

·

Mlifqo^rj^qfpjb

·

>cb`ţfrkfabkq^ob

·

>ajfkfpqo^ob^abaoldroffkqo^sbklp

C+

@lilkfw^ob^j^pfsă^`lilkrirf`rPqobmql`l``rp_lsfp

 

_flqfmUşf

qrjl^ob`lilob`q^iăp^rj^i^afbfkci^j^qlofb`olkf`ă

fkqbpqfk^iă

Ċ

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Tabelul 4. Regimurile de profilaxie antibacteriană

Antibioticoprofilaxia se limitează la pacienţii cu cel mai mare risc de EI care efectuiază proceduri stomatologice cu risc foarte mare

 

Doză unică cu 30-60 minute ðnainte de procedură

Situaţia

Medicament

Adulţi

Copii

Fără^ibodfbi^Mbkf`fifkăp^r

>jluf`fifkăp^r

/+-dm,lp^rf,s

A-jd,hdlo^ip^rf,s

>jmf`fifkă

>jmf`fifkă4.5

>ibodfbi^Mbkf`fifkăp^r

@ifka^jf`fkă

B--jdm+lp^rf,s

/-jd,hdm+l+p^rf,s

>jmf`fifkă

Notă: *>iqbok^qfsă”@bc^ibufk/dof,sp^rA-jd,hdf,si^`lmff+@bc^wlifkp^r@bcqof^ulkă.d f,si^^ariţfp^rA-jd,hdf,si^`lmff+ @bc^ilpmlofkbibkrqob_rfbrqfifw^qbi^m^`fbkţff`r^k^cfi^ufb)^kdflbabjp^rroqf`^ofb) ^măorqbarmă^ajfkfpqo^ob^abMbkf`fifkăp^r>jmf`fifkă+

C.2.2.2. Anamneza

Caseta 2. Recomandări pentru evaluarea anamnezei unui pacient cu suspecţie la EI

Cb_o^p^rpr_cb_ofifq^qb^)cofpl^kbib)qo^kpmfo^ţffibkl`qrokbşfp`ăabob^mlkabo^iăslocfpbjkbib`ifkf`b`^ob ékaorjăm^`fbkqripmob`lkpriq^ţfbjbaf`^iăp^rpmfq^ifw^ob+Bs^ir^ob^m^`fbkqrirf`rpfkaoljcb_ofipbs^ c^`bcărăékqÝowfbob)ékp`lmribu`iraboffBU+ Se vor lua ðn consideraţieF

· @^o^`qbori)s^ilofibşfaro^q^cb_obf)`lkafţffibab^m^ofţfbG

· Pbjkbib`^oaf^`bşfbuqo^`^oaf^`b4j^kfcbpqăof`bob_o^ib)obk^ib)l`ri^ob5^măorqbob`bkqG

· Bs^ir^ob^mol_^_fifqăţffj^i^affilo`^oaf^`bmobbufpqbkqb(Tabelul 2)

· SÝopq^mbopl^kbiloG`ljlo_fafqăţfib(Tabelul 3).

· Bs^ir^ob^mol`babbilobcb`qr^qbékriqfjbibBirkf(Tabelul 4)

*BUqob_rfbprpmb`q^qăi^rkm^`fbkq`rj^i^aff`^oaf^`bmobbufpqbkqbşfcb_oăfkbumif`^_fiăab`bimrţfkl p^mq^jÝkăp^rpr_cb_ofifq^qbi^sÝopqkf`f)`Ýq şfék`^wabcb_oăi^mbopl^kb`b^ajfkfpqob^wăaoldrof fkqo^sbklpG

Caseta Ċ 3. Criterii, care impun un grad ðnalt de suspiciune pentru EI

.+

Prpmf`frkb`ifkf`ăék^iqă4fkaf`^ţfbrodbkqămbkqorp`obbkfkdrib`l`^oafldo^cf`şfmlpf_fiăpmfq^ifw^ob5

·

Xbwfrkbs^isri^oăklr^măorqă,prcirabobdrodfq^ob

·

Bsbkfjbkqbbj_lif`bablofdfkbkb`rklp`rqă4fkc^o`qb`bob_o^ibp^robk^ib)bq`+5

·

Pbmpfpablofdfkbkb`rklp`rqă

·

Tbj^qrofb)diljborilkbcofqă şfprpmb`ţfbabfkc^o`qobk^i

·

Cb_oămirpF

ü

Molqbwbfkqo^`^oaf^`b)m^`bj^hbo)abcf_ofi^qlofkqo^`^oaf^`

ü

@lkafţffmobafpmlw^kqbmbkqorBUafkdormriabofp`ék^iq

ü

>ofqjffsbkqof`ri^obob`bkq^măorqbp^rabobdiăofab`lkar`bob

ü

Mofjbibj^kfcbpqăof^ibfkprcf`fbkţbf`^oaf^`b

ü

Tbjl`riqrofmlwfqfsb4a^`ăjf`ollod^kfpjriabqbojfk^qbpqbqfmf`mbkqorBUs^isbilok^qfsbp^r

molpqbqf`b5

ü

Y^kfcbpqăof`rq^k^qb4klarifLpibo)ibwfrkfV^kbt^v5p^rj^kfcbpqăoflcq^ijf`b4mbqbOlqe5

ü

Ukcfiqo^ţffmrijlk^objriqfcl`^ib,o^mfap`efj_ăql^ob4BUab`loaaobmq5

ü

>_`bpbmbofcbof`b4obk^ib)pmibkf`b)^jăarsbflpl^pb5ablofdfkbkb`rklp`rqă

ü

Mobafpmlwfţfb şffkqbosbkţffob`bkqbaf^dklpqf`b,qbo^mbrqf`b`rklp`rqbaobmqobwriq^q^_^`qbofbjfbf

/+

pbjkfcf`^qfsbék^k^jkbpqf`+ Prpmf`frkb`ifkf`ăgl^pă+Cb_oăkb^pl`f^qă`r`lkafţffibbumrpbj^fprp

Ċ

ěġĊ

C.2.2.3. Examenul clinic Bu^jbkri`ifkf`qob_rfblofbkq^qékabmfpq^ob^pfkaoljrirfcb_ofi)a^qbilocfwf`b`^o^`qbofpqf`bBU şf `ljmif`^ţffiloj^i^afbf+

Caseta 4. Manifestările clinice ale pacientului cu EI La suspecţia endocarditei infecţioase - temperatura trebuie măsurată la fiecare 3 ore.

· cb_oăFeb`qf`ăp^rlkari^kqă)^pl`f^qă`rcofpl^kb)qo^kpmfq^ţffkl`qrokbG

· pr_cb_ofifq^qb4i^sÝopqkf`f)i^mbopl^kbibfjrkl`ljmoljfpb)i^m^`fbkţff`rfkprcf`fbkţă

`^oaf^`ă`lkdbpqfsă)`rfkprcf`fbkţăobk^iă5G

^iqbo^ob^pqăoffdbkbo^ib)`bc^ibb)jf^idff)^oqo^idff)alop^idffgl^pb)^pqbkfb)fk^mbqbkţă) p`ăabobmlkabo^iăG Trebuie examinate minuţios tegumentele şi mucoasele pacientului

·

· m^il^ob^mfbiff‘`^cb^`ri^mqb’G

· mbqbşff4ékpm^ţfrprmo^`i^sf`ri^o)mbjr`l^p^grd^iă şf`lkgrk`qfs^iă5G

· ebjlo^dffpr_rkdef^ibifkf^ob‘ék^ş`efb’4olşrfk`efp5G

· klarifLpibo4klarifjf`folşff)abafjbkpfrkfibrkrf_l_abj^wăob)pfqr^ţfi^kfsbiri

mrimbfabdbqbilo)`^obmbopfpqă`Ýqbs^lobp^rwfib5G

· ibwfrkfV^kbt^v4klarifebjlo^df`fkbarobolşf`^ob^m^oi^kfsbirim^ijbiloşfmi^kqbilo5G

abdbqbefml`o^qf`bG Auscultaţia cordului relevăapariţia de sufluri noi sau modificarea celor preexistente:

·

·

prcirofib`^oaf^`bprkqmobwbkqb^mol^mbqlqab^rk^)`rbubmţf^mbofl^abfmob`l`bp^ri^rqfifw^qloffab

aoldroffkqo^sbkl^pb4ék^cb`q^ob^s^isbfqof`rpmfab5

Parametrii hemodinamiciF

· qbkpfrkb^^oqbof^iăaf^pqlif`ăpbsbop`ăwrqăfkaf`ăobdrodfq^ob^loqf`ăj^kfcbpqăékBU`r^cb`q^ob^

s^isbf^loqf`bG

· cob`sbkţ^`lkqo^`ţffilo`^oaf^`b”abpblofq^ef`^oafb

Semne extracardiace:

· pmibkljbd^ifbjlabo^qăG

· j^kfcbpqăofl`ri^ob”mbqbOlqe4ebjlo^dffobqfkfbkbls^ib`r`bkqori`i^o)m^i5Gkbsofqălmqf`ăG

· bmfpl^abbj_lif`b4bj_liff`bob_o^ib”ékBU`^rw^qăabPq^mevil`l``rp^robrp`rsbdbq^ţffmbs^i

^loq^iă)bj_lif^^+cbjro^ib”abpblofobwriq^qriBUcrkdf`b)bj_lifbmrijlk^o㔠ékBUab`loaaobmq

RAUS5G

· j^kfcbpqăofobk^ib4fkprcf`fbkţăobk^iăa^qlo^qăbj_lififiloobk^ib p^rdiljborilkbcofqbf`r`ljmib

fjrkb5

Notă:

'BUqob_rfbprpmb`q^qă^qrk`f`Ýkabpqbmobwbkqrkprcir`^oaf^``rcb_o^fkbumif`^_fi^ab`bimrţfkl p^mq^jÝkăi^rkm^`fbkq`rj^i^aff`^oaf^`bmobbufpqbkqb)p^rpr_cb_ofifq^qbi^sÝopqkf`f)`Ýq şfék`^wab cb_oăi^mbopl^kb`b^ajfkfpqob^wăaoldroffkqo^sbklrp+

'Ék`lkpb`fkţăm^`fbkqris^cffksbpqfd^qB`l*`^oafldo^cf`)fpbsloob`liq^ebjl`riqrofafk0sbkbmbofcbof`b

şfpbs^ékaobmq^i^`lkpriq^ţf^`^oaflildrirf+ 'Krpbslofkaf`^^kqf_flqf`bm^`fbkţfilocb_ofifék^fkqbab^cfpq^_fifqrkaf^dklpqf`abcfkfq şfékablpb_f ék^fkqbab^cfob`liq^qbebjl`riqrof+

C.2.2.4. Investigaţii paraclinice M^`fbkqris^bcb`qr^F

· Uksbpqfd^ţffl_ifd^qloffob`lj^ka^_fib)`lkcloj`ofqboffilombkqorBU

· Uksbpqfd^ ţ ffl_ifd^qloffaborqfk ă  · Uksbpqfd^

· Uksbpqfd^ţffl_ifd^qloffaborqfkă

· Uksbpqfd^ţff`ljmibjbkq^ob)i^fkaf`^ţff4ék`ljmif`^ţffibBU5

Ċ

ěĢĊ

@lkcloj`ofqboffiloabaf^dklpqf`^bkal`^oafqbffkcb`ţfl^pbobsfwrfqb)ARWB.EE1)`bib/`ofqboff

j^globmbkqorpq^_fifob^af^dklpqf`rirfabcfkfqabBUpb`lkpfaboă^cfebjl`riqro^mlwfqfsă`r jf`ollod^kfpjbfabkqf`bafkqobfob`liqăofpbm^o^qbşfabjlkpqo^ob^fjmif`ăoffbkal`^oarirfmofkbu^jbkri

b`l`^oafldo^cf`4B`l@S5+

Tabelul 5. Criteriile de diagnostic a endocarditei infecţioase revizuite, DUKE(1994)

   

.+Yf`ollod^kfpjbqfmf`b

Pqobmql`l``rpsfofaf^kp)

prdbpqfsbmbkqorBUék/

Pqobmql`l``rp_lsfp)

ebjl`riqrofafcbofqb

SbojbkfafkdormriT>@BW

 

Tbjl`riqrof

Pq^mevil``l`rp^robrp) Bkqbol`l`fal_Ýkafţfék`ljrkfq^qbék^_pbkţ^rkrf cl`^omofj^o+

4T@5mlwfqfsb

`rF

 

@lufbi^_rokbqqf4T@rkf`ămlwfqfsă5p^rrkqfqorab

^kqf`lomfUdSabc^wăU;.FD--

/+Yf`ollod^kfpjb

@bimrţfk/ebjl`riqrofmlwfqfsbafkmol_bmobibs^qb

@ofqboffj^glob

prdbpqfsbmbkqorBUék

i^j^fjriqab./lobafcbobkțăp^r

ebjl`riqrofmlwfqfsb

Ql^qb`bibqobfp^rlj^glofq^qbab`bimrțfk1`riqrof

obmbq^qb

pbm^o^qb4`rmofj^şfriqfj^mol_ămobibs^qbi^fkqbos^i

ab`bimrţfk.loăafcbobkță5

 

Als^aă^

 

· Sbdbq^ţff4mobwbkţ^abj^pblp`fi^kqbfkqo^`^oaf^`b

fjmif`ăoff

il`^ifw^qbmbF

bkal`^oarirf

ü s^isbib`^oaf^`b

 

ü mbpqor`qrofibabprpţfkbob

B`l`^oafldo^cfbmlwfqfsă

ü ék`^ib^dbqrirfobdrodfq^kq

mbkqorBU

ü mbj^qbof^ibmolpqbqf`b

· >_`bpbabfkbi

· Abefp`bkţăm^oţf^iăklră^rkbfs^isbmolqbqf`b

· Obdrodfq^qbs^isri^oăklr^măorqă

   

@lkafţffmobafpmlw^kqb`^oaf^`bmbkqorBUp^r`lkprj^qlofabaoldroffkqo^sbklp

 

Cb_oămbpqb0D¸@

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