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Old 11-03-2011
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Heart Infective Endocarditis Antimicrobial Prophylaxis

As the youngest member of the hospital staff organization, you have been privileged with the honor of heading the service improvement committee. One of the committee’s jobs is to review recent cases, looking for areas where preventive health measures may be incorporated. In the past, the service improvement committee has implemented valuable procedural reforms that have increased the use of perioperative beta-blockers, increased pneumonia vaccination screening, and shortened door to cardiac catheterization time. Currently, the committee is reviewing antimicrobial prophylaxis for infective endocarditis. A large number of patients who undergo invasive procedures have preexisting conditions that place them at moderate to high risk for developing infective endocarditis from transient seeding of the bloodstream during surgery or invasive procedures. Of the following cases currently being reviewed by the committee, which one is most likely to benefit from antimicrobial prophylaxis?
A. A 72-year-old man with aortic stenosis who is planned for cardiac catheterization
B. Endotracheal intubation in a 61-year-old man who has a mechanical heart valve
C. Esophageal dilatation in a 38-year-old woman with mitral regurgitation and achalasia
D. Transesophageal echocardiography in a 52-year-old man with mitral regurgitation
E. Upper endoscopy in a 42-year-old man with a previous history of infective endocarditis
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Old 11-03-2011
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B. Endotracheal intubation in a 61-year-old man who has a mechanical heart valve
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Old 11-03-2011
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E... previous IE undergoing UGIE
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Old 11-03-2011
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i would go with Choice B.
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E. Upper endoscopy in a 42-year-old man with a previous history of infective endocarditis


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Old 11-03-2011
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Endoscopy don't need prophylaxis so i'd like to go for >B. Endotracheal intubation in a 61-year-old man who has a mechanical heart valve
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Old 11-04-2011
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The correct answer is C. The decision to give antimicrobial prophylaxis to prevent infective endocarditis is based on two factors: the preexisting risk of the patient, and the risk of the surgery. All of these patients are at moderate to high risk of developing endocarditis from transient bacterial seeding because they all have valve abnormalities. However, with the exception of esophageal dilatation (a traumatic procedure that induces bacterial translocation and microtrauma), these procedures are generally low-risk; they result in little or no seeding of the blood. Cardiac catheterization (choice A), including balloon dilatation; endotracheal intubation (choice B); transesophageal echocardiography (choice D); and routine endoscopy (choice E) specifically do not require antibacterial prophylaxis.
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Old 11-04-2011
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most unexpected
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Old 11-04-2011
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As far as ,I know ..patient with MR,MS,AR,AS, HOCM N ASD ..don't require prophylaxis .. so in this case, why 'C' is the right answer. Need more explanation to clear this point, thnx !
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Old 11-04-2011
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http://www.asge.org/WorkArea/showcontent.aspx?id=4298
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