What determines the need of premedication?
- Past degree of risk
- Now: potential worst outcomes
- **NOT FEAR**
- Premed does not equal protection
How much evidence supports that antibiotic prophylaxis defends against IE or presthetic joint infeciton?
No scientific evidence
What are the pathogen species within bacteremia?
Viridans streptococci, staphlococcus aureus
How much higher is the increase of infective endocarditis in patients with prosthetic valves and previous history of endocarditis?
400 fold increase
What are the AHA guidelines for when to use prevention measures of bacterial endocarditis?
- Prosthetic cardiac valve
- Previous history of infective endocarditis
- Congenital heart disease
- Cardiac transplant
What is TGA (transposition of the great arteries)?
Trasposition = swapped, vessels are reversed, abnormal positioning - often accompanied by other heart defects
Needs surgical correction
Babies who have surgery to correct TGA sometimes have associated conditions later in life, what are they?
- Leaky heart valves
- Coronary artery problems
- Heart failure
- ** Requires lifelong follow-up with a cardiologist**
A cardiac shunt (congenital defect) does not equal arteriovenous shunt, true or false?
Ateriovenous shunts are used for patients undergoing dialysis
At 60 minutes, what is the percentage of bactermia with IE-related species?
- 5% - extraction/placebo group
- 2% - toothbrushing group
- 0% - extraction/amoxicillin group
What is the second most common cause of prosthetic joint failure?
What is a risk factor for hematogenous prosthetic joint infection?
Bactermia, especially with Staphylococcus aureus
What bacteria is the most common cause of transient bactermia after dental procedures that result in trauma to gingiva or oral mucosa?
How much do the viridans-group streptococci account for, with hematogenous prosthetic joint infections?
True of false - cumulative exposure to transient bactermia through daily activities is several times higher than following a single exposure during a dental procedure?
What can potentially decrease the frequency of bacteremia from daily activities?
Good oral hygiene
What bacteria were the most commonly encountered organisms isolated from infected joints?
What bacteria species can be found from dental procedures?
- Viridans-group streptococci
- beta-hemolytic streptococci
- gram-positive anaerobes
Why do orthopedic surgeons prefer cephalosporins over amoxicillin?
Because cephalosporins enter the synovial fluid
cephalexin (Keflex) appears first on guidelines
What are the 3 main recommendations for prescribing premeds?
- Consider discontinuing the practice of routinely prescribing prophylatic antibiotics for patients with hip and knee prosthetic implants
- The work grouip was unable to recommend for or against the use of topical oral antimicrobials
- It's the opinion of the work group that patients with joint implants maintain appropriate oral hygiene
Who needs prophylaxis?
- Pins, plates, screws?
- Breast, dental or corneal implants?
- Penile implants?
- hx of IV drug abuse if valve damage?
- Coronary stents (not case of IE)?
- Pacemakers, defibrillators?
Do patients undergoing dialysis require a prophylaxis?
No for fistula access
Do these patients need prophylaxis?
- History of taking Fen-Phen?
- Damage to WBCs
- Organ transplants? (chemo, immunosuppressents)
- History of IV drug abuse?