Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines

Eliana Castillo; Laura A Magee; Peter von Dadelszen; Deborah Money; Edith Blondel-Hill; Julie van Schalkwyk

doi:10.1016/S1701-2163(16)32944-9

Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines

J Obstet Gynaecol Can. 2008 Sep;30(9):796-799. doi: 10.1016/S1701-2163(16)32944-9.

Authors

Eliana Castillo¹, Laura A Magee², Peter von Dadelszen³, Deborah Money⁴, Edith Blondel-Hill⁵, Julie van Schalkwyk⁴

Affiliations

¹ Department of Medicine, University of British Columbia, Vancouver BC; Children's and Women's Health Centre of British Columbia, Vancouver BC.
² Department of Medicine, University of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, Child and Family Research Institute, University of British Columbia, Vancouver BC; Women's Health Research Institute, Vancouver BC.
³ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, Child and Family Research Institute, University of British Columbia, Vancouver BC; Children's and Women's Health Centre of British Columbia, Vancouver BC.
⁴ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Children's and Women's Health Centre of British Columbia, Vancouver BC; Women's Health Research Institute, Vancouver BC.
⁵ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC; Children's and Women's Health Centre of British Columbia, Vancouver BC.

PMID: 18845049
DOI: 10.1016/S1701-2163(16)32944-9

Abstract

The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis. Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and/or gynaecological procedures, not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis. This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from "randomly occurring" bacteremia (e.g., from brushing teeth) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective. A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implications is presented.

MeSH terms

American Heart Association
Antibiotic Prophylaxis*
Endocarditis / prevention & control*
Female
Gynecologic Surgical Procedures
Humans
Practice Guidelines as Topic*
Pregnancy
Pregnancy Complications, Infectious / microbiology
Risk Factors
United States