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Incidence of bacteremia at dilation and curettage
1Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, D.C.
Insights
The American Heart Association
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Cardiology
Background:
- The American Heart Association (AHA) advises against prophylactic antibiotics for dilation and curettage (D&C) unless septic abortion or prosthetic valves are present.
- Current recommendations stem from retrospective case analyses, lacking prospective validation.
- Subacute bacterial endocarditis is a potential complication of procedures with bacteremia.
Purpose of the Study:
- To prospectively evaluate the incidence of bacteremia following D&C for noninfectious indications.
- To assess the risk of infectious complications associated with D&C.
- To validate existing AHA recommendations regarding antibiotic prophylaxis for D&C.
Main Methods:
- A prospective study involving 20 patients undergoing D&C for noninfectious reasons.
- Aerobic and anaerobic blood cultures were collected before and during the procedure.
- Incidence of bacteremia was determined by positive blood cultures post-D&C.
Main Results:
- All baseline blood cultures were negative.
- One patient (5% incidence) showed Lactobacillus bacteremia after D&C.
- This incidence aligns D&C with other low-risk diagnostic procedures for endocarditis pathogenesis.
Conclusions:
- The study prospectively confirms a low incidence of bacteremia after D&C for noninfectious indications.
- Findings support the current American Heart Association guidelines not recommending routine prophylactic antibiotics.
- Dilation and curettage is categorized as a low-risk procedure concerning bacterial endocarditis.
Abstract:
The American Heart Association does not recommend prophylactic antibiotics for patients undergoing dilation and curettage (D & C) except in the case of septic abortion or the presence of prosthetic valves. This recommendation is based on a retrospective analysis of case reports of infectious complications of D & C. To date we are unaware of prospective studies that answer this question. At a community hospital we studied 20 patients undergoing D & C for noninfectious indications. Aerobic and anaerobic blood cultures were performed before and during the D & C. All baseline cultures were negative. In one patient we were able to isolate Lactobacillus after the D & C, thus finding a 5% incidence of bacteremia. That places D & C in the same risk category as other diagnostic procedures considered low risk in the pathogenesis of subacute bacterial endocarditis. Our study thus validated the recommendations made by the American Heart Association.