Infective endocarditis following gastrointestinal and genitourinary procedures: an argument in favour of prophylaxis

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• The 2007 American Heart Association guidelines removed gastrointestinal (GI) and genitourinary (GU) procedures from infective endocarditis (IE) prophylaxis indications.
• The justification for this removal requires an understanding of the contribution of GI and GU procedures to IE occurrence.

Purpose of the Study:

• To estimate the contribution of GI and GU procedures to the occurrence of IE.
• To evaluate the appropriateness of removing GI and GU procedures from IE prophylaxis guidelines.

Main Methods:

• Prospective collection of 212 IE episodes over 7 years.
• Analysis of patient history for invasive GI, GU, and dental interventions within 3 months of IE diagnosis.
• Microbiological analysis to identify causative pathogens.

Main Results:

• 20 IE cases (9%) were associated with invasive GI and GU procedures.
• 17 IE cases (8%) were linked to dental interventions.
• Enteric organisms, notably Enterococcus faecalis, were significantly more prevalent in the GI/GU group compared to other patients.
• Viridans streptococci, common in the dental group, were absent in the GI/GU group.

Conclusions:

• GI and GU procedures represent a non-negligible risk factor for IE acquisition.
• The distinct pathogen profile in the GI/GU group strongly suggests a procedural link to IE.
• Adults at high risk for IE undergoing surgical GI and GU procedures should receive prophylaxis including an anti-enterococcal agent.