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Systemic lupus erythematosus: a consideration for antimicrobial prophylaxis
Insights
Systemic lupus erythematosus (SLE) patients have a high risk of heart valve damage and bacterial endocarditis. Antibiotic prophylaxis is recommended for all SLE patients undergoing dental procedures to prevent this serious complication.
Area of Science:
- Cardiology
- Rheumatology
- Infectious Diseases
Background:
- Systemic lupus erythematosus (SLE) frequently causes endothelial damage to heart valves, mirroring rheumatic heart disease.
- Bacterial endocarditis affects 1% to 4% of SLE patients, a higher incidence than seen with rheumatic heart disease.
Purpose of the Study:
- To highlight the significant risk of bacterial endocarditis in patients with SLE.
- To emphasize the need for preventive measures in at-risk SLE populations.
Main Methods:
- Review of existing literature on SLE, heart valve disease, and bacterial endocarditis.
- Comparison of endocarditis incidence in SLE patients versus those with rheumatic heart disease and prosthetic valves.
Main Results:
- Endothelial heart valve damage occurs in 50% of SLE patients.
- Bacterial endocarditis incidence in SLE patients exceeds that in rheumatic heart disease patients.
- Current inability to precisely identify SLE patients at highest risk for endocarditis.
Conclusions:
- All patients with SLE should be considered at risk for bacterial endocarditis.
- Antibiotic prophylaxis, following American Heart Association guidelines, is recommended for SLE patients undergoing dental procedures with potential for bacteremia.
Abstract:
Endothelial damage to heart valves, similar to that seen with rheumatic heart disease, occurs in 50% of all patients with systemic lupus erythematosus. Bacterial endocarditis is a consequence in 1% to 4% of these patients. This rate is greater than the incidence of endocarditis after rheumatic heart disease and compares favorably with the incidence of endocarditis in patients with prosthetic heart valves. At present, it is not possible to accurately delineate the subpopulation of patients with SLE that is at risk for this disease; hence, it is recommended that antibiotic prophylaxis (standard regimen suggested by the American Heart Association) be considered for all patients with systemic lupus erythematosus undergoing dental procedures associated with transient bacteremias.