Dental treatment, surgical procedures, or instrumentation involving mucosal surfaces or contaminated tissue may cause transient bacteremia. Blood-borne bacteria may lodge on damaged or abnormal heart valves or on endocardium near congenital anatomic defects and result in bacterial endocarditis or endarteritis. However, it is impossible to predict which patients will develop this infection or which procedures will be responsible. Therefore, prophylactic antibiotics are recommended for patients at risk who are undergoing those procedures most likely to cause bacteremia. It is important that such antibiotics be initiated shortly before, not several days before, a procedure. Certain patients, for example, those with prosthetic heart valves and surgically constructed systemic-pulmonary shunts or conduits, are at higher risk of endocarditis than others (Table 1). Likewise, certain dental (eg, extractions) and surgical (eg, genitourinary [GU] tract) procedures are much more likely to initiate significant bacteremia than are others (Table 2). Although the importance of such factors
Shulman ST, Amren DP, Bisno AL, et al. Prevention of Bacterial Endocarditis: A Statement for Health Professionals by the Committee on Rheumatic Fever and Bacterial Endocarditis of the Council on Cardiovascular Diseases in the Young of the American Heart Association. Am J Dis Child. 1985;139(3):232–235. doi:10.1001/archpedi.1985.02140050026013
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