INFECTIVE ENDOCARDITIS, RISK-FACTORS, PRE VENTION

Infective endocarditis, resulting from deposition of circulating micro organisms during a period of bacteremia on damaged endothelial heart v alves, remains a serious disease. Its overall incidence did not declin e in recent years, 24 cases/year/million inhabitants, in France. This can be explained by a modification of the type of underlying cardiac c onditions with regression of rheumatic fever and increase of degenerat ive heart diseases, prosthetic valves and mitral valve prolapse. The r isk of bacterial seeding on a damaged valve remains difficult to evalu ate, the highest risk being for patients with prosthetic valve, previo us infective endocarditis and cyanotic congenital heart disease. A cas e-control study, done in 1991, confirmed that procedures are risk fact ors for infective endocarditis and that the multiplicity of procedures increases the risk. A French consensus conference on the prophylaxis of infective endocarditis has updated the recommendations for antibiot ic prophylaxis. Two groups of cardiac patients were identified, based on the incidence and the severity of endocarditis occurring in patient s with these conditions, 1) patients considered at risk which require specific prophylaxis, and 2) patients considered non at risk which do not require antibiotic prophylaxis. Procedures which require antibioti c prophylaxis are dental procedures and specific gastrointestinal and urologic procedures. As complex protocols are associated with poor com pliance by practitionners and patients, the jury has aimed for simplic ity and feasibility.