Bacteremia procedures causing

The use of antimicrobials for this purpose requires consideration of the types of patients who are at risk the procedures causing bacteremia the organisms that are likely to cause endocarditis and the pharmacokinetics, spectrum, cost, and ease of administration of available agents. The objective... 

Answer B (Amoxicillin). The multiple extractions can lead to bacteremia while the mitral valve stenosis and cardiac insufficiency place him at risk for developing endocarditis. The present American Heart Association guidelines indicate amoxicillin (3 gm 1 hour prior to procedure and 1.5 gm 6 hours after original dose.) Vancomycin would only be appropriate if the patient was allergic to penicillins. Tetracycline and cotrimoxazole are bacteriostatic and not effective against the viridans group of Streptococci, the usual causative organism. Imipenem is also inappropriate since its spectrum is too broad. 

There is a small risk for bacterial endocarditis in HCM patients with LV outflow obstruction under resting conditions and in those with intrinsic mitral valve disease. Patients undergoing dental or selected surgical procedures that cause blood-borne bacteremia should receive appropriate antibiotic therapy. The administration of nitroglycerin and digoxin generally is discouraged in the presence of a LV outflow obstruction. ... 

Antimicrobial prophylaxis is used as an attempt to prevent IE in patients at high risk (such as persons with prosthetic heart valves) before a bacteremia-causing procedure (e.g., dental extraction). 

The common practice of administering antibiotics to high-risk individuals before a bacteremia-causing procedure is controversial. Despite limited data supporting this approach and the fact that 1 00% compliance with AHA preventative guidelines would have only a modest benefit, the use of single-dose antibiotics for the prevention of endocarditis remains a standard of care. 

Bacteremia accompanies many everyday events, such as brushing the teeth and chewing, although certain medical and surgical procedures are more likely to cause a transient bacteremia (see Tables 109-11 and... 

Roberts GJ. Dentist are innocent Everyday bacteremia is real culprit A review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis. Pediatr Cardiol 1999 20 317-325. 

Infection of autogenous accesses is extremely rare, while AVG could be complicated with two main types of infections (1) postoperative infections attributable to the initial access procedure with an early onset (<1 month) and an incidence of 0.8%, representing only 6% of the total AVG infections and (2) late infections caused by punctures, representing >50% of the total, with an annual rate of 5% [20]. Bacteremias are 5 times more frequent in grafts than in AVF (3.1 vs. 0.6 bloodstream infections per 100 patient months) [21]. Staphylococcus species are the most common culprits in over 70% of the cases [22]. 

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