FATAL STAPHYLOCOCCUS-AUREUS INFECTIVE ENDOCARDITIS - THE DENTAL IMPLICATIONS

Infective endocarditis remains an important and life-threatening infec tion despite improvements in diagnosis and management. There is curren tly a greater role for nosocomial acquisition of organisms and immunos uppression in the pathogenesis of this disease and emergence of a broa der spectrum of infective organisms including those not commonly isola ted from the mouth such as staphylococci. We report a case of infectiv e endocarditis caused by Staphylococcus aureus in which the patient de veloped disseminated intravascular coagulation and multiple septic inf arcts resulting in a frontal robe brain abscess. Multiple dental extra ctions were complicated by delayed postextraction hemorrhage and the i mmediate cause of death was abdominal hemorrhage. The dental managemen t in infective endocarditis should be planned in consultation with the attending physician, and should take into account both the causative organism and the presence of complications. When the oral cavity canno t be proven as the bacterial source for infective endocarditis, the im mediate dental management should be directed toward improving the pati ent's oral hygiene and providing pain relief. Definitive long-term tre atment, including any extractions, is ideally delayed until the patien t has fully recovered from the infective endocarditis and its attendan t complications.