Prevention of prosthetic valve endocarditis

Area of Science:

• Infectious Diseases
• Cardiovascular Surgery
• Microbiology

Background:

• Prosthetic valve endocarditis (PVE) is traditionally classified into early (EPVE) and late (LPVE) forms, distinguished by onset within 60 days post-operation.
• Recent data indicate that the risk period for EPVE extends up to 12 months, necessitating a re-evaluation of prevention strategies.
• Nosocomial bacteremia is increasingly recognized as a significant factor in PVE development, demanding enhanced perioperative preventive measures.

Purpose of the Study:

• To highlight the evolving understanding of PVE timelines and risk factors.
• To emphasize the critical need for improved perioperative prevention strategies for PVE.
• To identify areas requiring further research for effective PVE prevention.

Main Methods:

• Review of recent actuarial and epidemiological studies on PVE.
• Discussion of the potential role of DNA-based typing for identifying causative organisms, particularly coagulase-negative staphylococci (CNS) in EPVE.
• Analysis of current preventive measures for both EPVE and LPVE, including antibiotic prophylaxis.

Main Results:

• The risk of EPVE extends beyond 60 days, potentially up to 12 months post-operation.
• Postoperative nosocomial bacteremia is a more significant contributor to EPVE than previously understood.
• Current preventive strategies for LPVE, relying on prophylaxis for predictable bacteremia, address only a small fraction of cases.

Conclusions:

• The prevention of all forms of PVE remains inadequate.
• There is an urgent need to re-emphasize existing preventive measures and invest in research to understand spontaneous bacteremias causing LPVE.
• Advanced methods like DNA typing may offer new insights into EPVE etiology and prevention.