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Intracerebral hemorrhage (ICH) is a subtype of stroke that results from spontaneous nontraumatic bleeding into the parenchyma of the brain. ICH accounts for 10% to 15% of all strokes and carries a disproportionately high risk of early death and long-term disability.1 Evidence for optimal treatment of ICH has lagged beh... |
Rigorous performance measures often take the strongest high- est-level guidelines and provide a method for directly measur- ing and reporting them with the goal of improving healthcare In addition to being evidence-based, they need to be developed with attention to feasibility and whether they are actionable and clearl... |
This performance measure report was approved by the American Heart Association Science Advisory and Coordinating Committee on January 16, 2018, and the American Heart Association Executive Committee on February 22, 2018. A copy of the document is available at http://professional.heart. org/statements by using either Se... |
The present document on ICH follows that ischemic stroke document substantially, borrowing wording when appro- priate to ensure similarity and harmonization across AHA/ ASA performance measure approaches.10 The process was overseen by the AHA/ASA Stroke Performance Oversight Committee and coordinated by an independent ... |
Previously existing performance measures that might apply to ICH that were already developed or endorsed by the National Quality Forum (NQF) or other groups such as the Centers for Disease Control and Prevention (CDC) or The Joint Commission (TJC) were also reviewed, and when possible, an attempt was made to harmonize ... |
These perfor- mance measures are meant to apply to the same condition described in the AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. 2 Thus, intracra- nial hemorrhage that is caused by an initial arterial or venous infarct does not apply, nor does intraparenchymal hemorrhage that occurs... |
Adapted from the Centers for Medicare and Medicaid Services ICD-10 Assessment and Maintenance Toolkit.13 Hemphill et al Performance Measures for ICH e245 Clinical Modification principal diagnosis codes for eligible patients with an ICH diagnosis in whom these performance measures are considered applicable. Dimensions o... |
It was felt important that all hospitals involved in the acute care of patients with ICH should be considered under these performance measures; thus, they apply to hospitals that might transfer a patient with ICH after initial assessment or receive that patient in transfer after initial stabilization at another acute c... |
The AHA/ASA Metrics for Measuring Quality of Care in Comprehensive Stroke Centers and Clinical Performance Measures for Adults Hospitalized With Acute Ischemic Stroke were reviewed for potential measures that would apply to ICH and should be considered for inclusion.10,19 Currently active per- formance measures from ot... |
Potentially applicable metrics from the AHA/ASA Metrics for Measuring Quality of Care in Comprehensive Stroke Centers manuscript were also added to the list for consideration.19 Standard criteria for performance measure development were determined before initial review and were derived from principles set forth previ- ... |
Each measure was then voted on for inclusion or exclu- sion with a standardized ballot form that included a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) on various aspects concerning suitability for submission as a performance measure. The ballots allowed measures to be rated separately on thes... |
Performance Measures for Adults Hospitalized With ICH Patient Population and Care Period The patient population is patients with spontaneous ICH, as defined in Definition of ICH in the Methods section, and the care period is the acute hospitalization for diagnosis and management of new ICH, from emergency department ar... |
The choice of method of case ascer- tainment and diagnosis via administrative billing codes versus chart review may depend on many registry-specific factors, including available resources, and the writing group endorses either method as a valid means of case ascertainment. Brief Summary of the Measurement Set Table 2 s... |
The move of hospitals and healthcare systems to electronic health records means that some data ele- ments can be automatically captured through these systems. Some data elements (eg, laboratory results or medications dis- pensed) have highly structured elements in electronic health records that facilitate automatic dat... |
Each performance mea- sure derives directly from a Level I or Level III recommenda- tion from the 2015 AHA/ASA ICH guidelines, although in several instances the specific wording and construction of the performance measures were revised or enhanced to harmonize with existing performance measures in use from other orga- ... |
When adoption outside the United States is considered, it is appropriate to consider the relevance of the specific aspects of each performance measure to local context and modify if needed.21 In addition, these performance mea- sures are intended to complement similar existing efforts by other organizations and regulat... |
Performance Measure NQF Endorsed CDC PCNASR/AHA GWTG-Stroke TJC CMS HIQRP AHA Ischemic Stroke Performance Measure New Measure 1 Baseline severity score 2 Coagulopathy reversal o 3 Venous thromboembolism prophylaxis o o o o o 4 Admission unit 5 Dysphagia screen: assessment o o 6 Dysphagia screen: management o o 7 Long-t... |
Numerous baseline severity scores for ICH exist,22 24 with the general goal of their use being to improve communication and risk stratification in terms of the patient s clinical condition and not to attempt to provide a precise numeric prognostic estimate. The ICH score is the most widely used and validated score for ... |
The 2015 ICH guidelines do not provide a Class I recommendation as to whether to use prothrombin complex concentrates or fresh-frozen plasma and do not specify a time frame in which therapy must be administered. The optimal therapy and timing for vitamin K antagonist reversal in acute ICH have received notable atten- t... |
The fact that this measure applies to the present- ing hospital (or a transfer-receiving hospital if therapy was not started at the initial hospital) was considered important because it emphasizes that just transferring a patient with ICH is insufficient to meet certain performance measures that per- tain to early aspe... |
Three measures in this ICH performance measure set are identical to those in theAHA/ASA ischemic stroke measure set. They relate to dysphagia screening and rehabilitation services. All 3 of these measures derive from an independent Class I rec- ommendation in the 2015AHA/ASA ICH guidelines. However, these are also issu... |
Similarly, the writing group recognized that the performance measure requiring assessment for rehabili- tation is associated with high compliance already and does not specify the type of rehabilitation services provided.29 Even so, the writing group felt it was important to have a performance measure that pertained to ... |
The 2015 AHA/ ASA ICH guidelines do not provide specifics for how this can be assessed; TJC indicates that specialized training, includ- ing certification in an educational course such as Emergency Neurological Life Support,33 would be a potential indicator. Hypertension is the most common cause of ICH, and the 2015 AH... |
The new AHA definition of hyperten- sion as a blood pressure >130/80 mmHg was incorporated as the target for initiation of treatment.34 Corticosteroids are not recommended for treating elevated intracranial pressure or cerebral edema in patients with ICH.2 There is limited information on the extent to which this still ... |
Quality assessment and performance measure implementation in stroke are still at an early stage, and it is hoped that future advancement of the evidence base for ICH care and broader experience with testing and implementation of performance measures will lead to revisions and expansions with the ulti- mate goal of impr... |
The ICH score is selected for use because it is the most commonly used validated baseline severity score and is required by TJC in its analogous measure. Source for Recommendation From the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 1. A baseline severity score should be performed... |
Coagulopathy Reversal: Percentage of patients with ICH and an INR >1.4 resulting from warfarin treatment who receive therapy to replace vitamin K dependent clotting factors within 90 min of ED presentation and who also receive intravenous vitamin K* Numerator Patients with an INR >1.4 resulting from warfarin treatment ... |
Source for Recommendations From the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage Patients with ICH whose INR is elevated because of vitamin K antagonist should have their vitamin K antagonist withheld, receive therapy to replace vitamin K dependent factors and correct the INR, and ... |
Venous Thromboembolism Prophylaxis: Percentage of patients with ICH who receive lower limb pneumatic compression on hospital day 0 or 1 Numerator Patients who received VTE prophylaxis using lower limb pneumatic compression on the day of admission (day 0) or the day after admission (day 1) or who have documentation why ... |
Method of Reporting Per patient: documentation of whether patient received pneumatic compression on hospital day 0 or 1 Per patient population: percentage of patients receiving pneumatic compression on hospital day 0 or 1 Challenges to Implementation Documentation variability in the description of whether pneumatic com... |
Admission Unit: Percentage of patients with ICH who are admitted to an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise Numerator Patients admitted to an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise Den... |
Method of Reporting Per patient: documentation of whether a patient was admitted to an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise Per patient population: percentage of patients with ICH admitted to an intensive care unit or dedicated stroke unit with physic... |
Dysphagia Screening Within 24 h: Percentage of patients 18 y of age with a diagnosis of ICH for whom there is documentation that a dysphagia screening was performed within 24 h of admission using a dysphagia screening tool approved by the institution in which the patient is receiving care Numerator Patients for whom th... |
Source for Recommendation From the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia (Class I; Level of Evidence B). Method of Reporting Pe... |
Passed Dysphagia Screen Before First Oral Intake of Fluids, Nutrition, or Medications: Percentage of patients 18 y of age with a diagnosis of ICH who were documented to have passed the most recent dysphagia screen before oral intake Numerator Included patients: Patients who were documented to have passed* the most rece... |
Source for Recommendation From the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia (Class I; Level of Evidence B). Method of Reporting Pe... |
In cases in which the most recent screening before first oral intake recommended a modified diet or restrictions, the first oral intake should have been consistent with the recommended modifications; if the first oral intake was not consistent with the recommended dietary modification (eg, the patient was provided thin... |
Randomized clinical trials have found early lowering of BP to be safe after spontaneous ICH. Source for Recommendations From the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage 1. BP should be controlled in all patients with ICH (Class I, Level of Evidence A). 2. Measures to control B... |
Assessed for Rehabilitation: Percentage of patients with ICH assessed for, or who received, rehabilitation services Numerator Patients who were assessed for, or who received, rehabilitation services during the hospital stay* Denominator Included patients: All patients with ICH Excluded patients: <18 y of age Length of ... |
The association between assessment and initiation of an appropriate rehabilitation plan is unmeasured, leaving uncertainty about the impact of the measure on improved outcomes. Documentation may be challenging to identify if rehabilitation services are delayed on the basis of anticipated institution of care limitations... |
Avoidance of Corticosteroid Use for Elevated Intracranial Pressure: Percentage of patients with ICH who do not receive corticosteroids during acute hospitalization Numerator Patients who do not receive intravenous or oral corticosteroids Denominator Included patients: All patients with ICH Excluded patients: <18 y of a... |
Analogous Measures Endorsed by Other Organizations None AHA indicates American Heart Association; ASA, American Stroke Association; COPD, chronic obstructive pulmonary disease; ED, emergency department; and ICH, intracerebral hemorrhage. |
Hemphill et al Performance Measures for ICH e259 Disclosures Writing Group Disclosures Writing Group Member Employment Research Grant Other Research Support Speakers Bureau/ Honoraria Expert Witness Ownership Interest Consultant/Advisory Board Other J. Claude Hemphill III University of California, San Francisco None No... |
A relationship is considered to be significant if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10000 or more of the fair market value of the entity. A relationship is ... |
Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Guidelines for the manage... |
K tter T, Blozik E, Scherer M. Methods for the guideline-based devel- opment of quality indicators: a systematic review. Implement Sci. 2012;7:21. doi: 10.1186/1748-5908-7-21. 10. Smith EE, Saver JL, Alexander DN, Furie KL, Hopkins LN, Katzan IL, Mackey JS, Miller EL, Schwamm LH, Williams LS; on behalf of the AHA/ASA S... |
MMWR Surveill Summ. 2009;58:1 23. 16. Reeves MJ, Parker C, Fonarow GC, Smith EE, Schwamm LH. Development of stroke performance measures: definitions, meth- ods, and current measures. Stroke. 2010;41:1573 1578. doi: 10.1161/STROKEAHA.109.577171. 17. McNaughton H, McPherson K, Taylor W, Weatherall M. Relationship between... |
An international standard set of patient-centered outcome measures after stroke. Stroke. 2016;47:180 186. doi: 10.1161/STROKEAHA.115. 010898. 22. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemor- rhage. Stroke. 2001;32:891 897. do... |
Frontera JA, Lewin JJ 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, del Zoppo GJ, Kumar MA, Peerschke EI, Stiefel MF, Teitelbaum JS, Wartenberg KE, Zerfoss CL. Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for health- care professionals from the Neurocritical Care Society an... |
doi: 10.1007/s12028-012-9741-x. 34. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS,Taler SJ,Thomas RJ,Williams KA Sr,Williamson JD,Wright JT Jr. 2017 ACC/AHA/AAPA/... |
Prevention of Infective Endocarditis Guidelines From the American Heart Association A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and... |
The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis,... |
Expert peer review of AHA Scientific Statements and Guidelines is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifier 3023366. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution o... |
Key Words: AHA Scientific Statements cardiovascular diseases endocarditis prevention antibiotic prophylaxis Infective endocarditis (IE) is an uncommon but life- threatening infection. Despite advances in diagnosis, antimi- crobial therapy, surgical techniques, and management of com- plications, patients with IE still h... |
Class IIb: Usefulness/efficacy is less well established by evidence/opinion. Class III: Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/ effective and in some cases may be harmful. Level of Evidence: Level of Evidence A: Data derived from multiple random- ized cl... |
The 1984 recom- mendations attempted to simplify prophylactic regimens by providing clear lists of procedures for which prophy- laxis was and was not recommended and reduced postpro- cedure prophylaxis for dental, GI, and GU tract procedures to only 1 oral or parenteral dose.12 In 1990, a more complete list of cardiac ... |
On the basis of the ACC and AHA Task Force on Practice Guide- lines evidence-based grading system for ranking recommen- dations, the recommendations in the AHA documents pub- lished during the past 50 years would be Class IIb, LOE C. Accordingly, the basis for recommendations for IE prophy- laxis was not well establish... |
Another reason that led the Committee to revise the 1997 document was that over the past 50 years, the AHA guide- lines on prevention of IE became overly complicated, making it difficult for patients and healthcare providers to interpret or remember specific details, and they contained ambiguities and some inconsistenc... |
1960 (8) Step I: prophylaxis 2 days before surgery with procaine penicillin 600 000 U IM on each day Step II: day of surgery: procaine penicillin 600 000 U IM supplemented by crystalline penicillin 600 000 U IM 1 hour before surgical procedure Step III: for 2 days after surgery: procaine penicillin 600 000 U IM each da... |
Potential Consequences of Substantive Changes in Recommendations Substantive changes in recommendations could (1) violate long-standing expectations and practice patterns; (2) make fewer patients eligible for IE prophylaxis; (3) reduce mal- practice claims related to IE prophylaxis; and (4) stimulate prospective studie... |
Cases of IE either temporally or remotely associated with an invasive procedure, especially a dental procedure, have frequently been the basis for malpractice claims against healthcare providers. Unlike many other infections for which there is conclusive evidence for the efficacy of preventive therapy, the prevention o... |
Future published data will be reviewed carefully by the AHA, the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, and other societies, and further revisions to the present document will be based on relevant studies. Pathogenesis of IE The development of IE is the net result of the complex interaction b... |
The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy. Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of... |
In the other, bacterial extracellular structures contribute to the formation of biofilm that forms on the surface of implanted medical devices. In both cases, staphylococcal adhesins are important virulence factors. Both FimA and staphylococcal adhesins are immunogenic in experimental infections. Vaccines prepared agai... |
In 1885, Osler22 noted an association between bacteremia from surgery and IE. Okell and Elliott23 in 1935 reported that 11% of patients with poor oral hygiene had positive blood cultures with viridans group streptococci and that 61% of patients had viridans group streptococcal bacteremia with dental extraction. As a re... |
Accordingly, the Committee undertook a critical analysis of published data in the context of the historical rationale for recommending antibiotic prophylaxis for IE before a dental procedure. The following factors were considered: (1) frequency, nature, magnitude, and duration of bacteremia associated with dental proce... |
Studies suggest that more than 700 species of bacteria, including aerobic and anaerobic Gram-positive and Gram- negative microorganisms, may be identified in the human mouth, particularly on the teeth and in the gingival crevic- es.24,37 40 Approximately 30% of the flora of the gingival crevice is streptococci, predomi... |
Cases of IE caused by oral bacteria probably result from the exposures to low inocula of bacteria in the bloodstream that result from routine daily activities and not from a dental procedure. Additionally, the vast majority of patients with IE have not had a dental procedure within 2 weeks before the onset of symptoms ... |
Impact of Dental Disease, Oral Hygiene, and Type of Dental Procedure on Bacteremia It is assumed that a relationship exists between poor oral hygiene, the extent of dental and periodontal disease, the type of dental procedure, and the frequency, nature, magnitude, and duration of bacteremia, but the presumed relationsh... |
Previous AHA guide- lines recommended antibiotic prophylaxis for dental proce- dures in which bleeding was anticipated but not for proce- dures for which bleeding was not anticipated.1 However, no data show that visible bleeding during a dental procedure is a reliable predictor of bacteremia.62 These ambiguities in the... |
In patients with underlying cardiac conditions, lifelong antibiotic therapy is not recommended to prevent IE that might result from bacteremias associated with routine daily activities.5 In patients with dental disease, the focus on the frequency of bacteremia associated with a specific dental procedure and the AHA gui... |
In patients who underwent a dental extraction, penicillin or ampicillin therapy compared with placebo diminished the percentage of viridans group streptococci and anaerobes in culture, but there was no significant difference in the percent- age of patients with positive cultures 10 minutes after tooth extraction.24,66 ... |
Roberts62 estimated that tooth brushing 2 times daily for 1 year had a 154 000 times greater risk of exposure to bacteremia than that resulting from a single tooth extrac- tion. The cumulative exposure during 1 year to bacteremia from routine daily activities may be as high as 5.6 million times greater than that result... |
Data from pub- lished retrospective or prospective case-control studies are limited by the following factors: (1) the low incidence of IE, which requires a large number of patients per cohort for statistical significance; (2) the wide variation in the types and severity of underlying cardiac conditions, which would re-... |
These authors reported that MVP, congenital heart disease (CHD), rheumatic heart disease (RHD), and previous cardiac valve surgery were risk factors for the development of IE. In that study, control subjects without IE were more likely to have undergone a dental procedure than were those with cases of IE (P 0.03). The ... |
Furthermore, there are numerous poorly documented case reports that implicate dental proce- dures associated with the development of IE, but these reports did not prove a direct causal relationship. Even in the event of a close temporal relationship between a dental procedure and IE, it is not possible to determine wit... |
Although the absolute risk for IE from a dental procedure is impossible to measure precisely, the best available esti- mates are as follows: If dental treatment causes 1% of all cases of viridans group streptococcal IE annually in the United States, the overall risk in the general population is estimated to be as low a... |
Fatal anaphylactic reactions were estimated to occur in 15 to 25 individuals per 1 million patients who receive a dose of penicillin.92,93 Among patients with a prior penicillin use, 36% of fatalities from anaphylaxis occurred in those with a known allergy to penicillin compared with 64% of fatalities among those with ... |
Fatal anaphylaxis from a cephalosporin is estimated to be less common than from penicillin, at approximately 1 case per 1 million patients.95 Fatal reactions to a single dose of a macrolide or clindamycin are extremely rare.96,97 There has been only 1 case report of documented Clostridium difficile colitis after a sing... |
Cardiac Conditions and Endocarditis Previous AHA guidelines categorized underlying cardiac conditions associated with the risk of IE as those with high risk, moderate risk, and negligible risk and recommended prophylaxis for patients in the high- and moderate-risk categories.1 For the present guidelines on prevention o... |
Per 100 000 patient-years, the lifetime risk (380 to 440) for RHD was similar to that (308 to 383) for patients with a mechanical or bioprosthetic cardiac valve. The highest lifetime risks per 100 000 patient-years were as follows: cardiac valve replacement surgery for native valve IE, 630; previous IE, 740; and prosth... |
On the basis of the data from Steckelberg and Wilson91 and others,2 it is clear that the underlying conditions discussed above represent a lifetime increased risk of acquisition of IE compared with individuals with no known underlying cardiac condition. Accordingly, when utilizing previous AHA guide- lines in the decis... |
Over time, the cardiac valve damaged by IE may undergo progressive functional deterioration that may result in the need for cardiac valve replacement. In native valve viridans group streptococcal or enterococcal IE, the spectrum of disease may range from a relatively benign infection to severe valvular dysfunction, deh... |
Nevertheless, most retrospective case series suggest that patients with complex cyanotic heart disease and those who have postoperative palliative shunts, conduits, or other prostheses have a high lifetime risk of acquiring IE, and these same groups appear at highest risk for morbidity and mortality among all patients ... |
No published data demonstrate convincingly that the administration of prophylactic antibiotics prevents IE associated with bacteremia from an invasive procedure. We cannot exclude the possibility that there may be an exceed- ingly small number of cases of IE that could be prevented by prophylactic antibiotics in patien... |
We believe that these revised guidelines are in the best interest of patients and healthcare providers and are based on the best available published data and expert opinion. Additionally, the change in emphasis to restrict prophylaxis for only those patients with the highest risk of adverse outcome should reduce the un... |
In these circumstances, it is important to obtain blood cultures and other relevant tests before administration of antibiotics intended to prevent IE. Failure to do so may result in delay in diagnosis or treatment of a concomitant case of IE. Regimens for Dental Procedures Previous AHA guidelines on prophylaxis listed ... |
During the past 2 decades, there has been a signifi- cant increase in the percentage of strains of viridans group streptococci resistant to antibiotics recommended in previous AHA guidelines for the prevention of IE. Prabhu et al135 studied susceptibility patterns of viridans group streptococci recovered from patients ... |
Dental Procedures for Which Endocarditis Prophylaxis Is Reasonable for Patients in Table 3 All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa* *The following procedures and events do not need prophylaxis: routine anesthetic injections t... |
There is no evidence that such therapy is effective for prophylaxis of IE, and their use might result in the develop- ment of resistance of viridans group streptococci and other microorganisms to these and other antibiotics. In Table 5, amoxicillin is the preferred choice for oral therapy because it is well absorbed in... |
We do not recommend antibiotic prophylaxis for bronchoscopy unless the procedure involves incision of the respiratory tract mucosa. For patients listed in Table 3 who undergo an invasive respiratory tract procedure to treat an established infection, such as drainage of an abscess or empy- ema, we recommend that the ant... |
*Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage. Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin. Wilson et al Prevention of Infective Endocarditis 1747 tract infections, particular... |
The high prevalence of resistant strains of enterococci adds further doubt about the efficacy of prophylactic therapy for GI or GU tract procedures. Patients with infections of the GI or GU tract may have intermittent or sustained enterococcal bacteremia. For patients with the conditions listed in Table 3 who have an e... |
For patients with the conditions listed in Table 3 who undergo a surgical procedure that involves infected skin, skin structure, or musculo- skeletal tissue, it may be reasonable that the therapeutic regimen administered for treatment of the infection contain an agent active against staphylococci and -hemolytic strepto... |
Antibiotic prophylaxis is no longer recommended for any other form of CHD, except for the conditions listed in Table 3. Antibiotic prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa only for patients with underlyi... |
If possible, it would be preferable to delay a dental procedure until at least 10 days after comple- tion of the antibiotic therapy. This may allow time for the usual oral flora to be reestablished. Patients receiving parenteral antibiotic therapy for IE may require dental procedures during antimicrobial therapy, parti... |
Prophylaxis at the time of cardiac surgery should be directed primarily against staphylococci and should be of short duration. A first- generation cephalosporin is most often used, but the choice of an antibiotic should be influenced by the antibiotic suscepti- bility patterns at each hospital. For example, a high prev... |
Such patients are at risk of acquired valvular dysfunction, especially during episodes of rejection. Endocarditis that occurs in a heart transplant patient is associated with a high risk of adverse outcome (Table 3).153 Accordingly, the use of IE prophylaxis for dental procedures in cardiac transplant recipients who de... |
The writing group also thanks Dr George Meyer for his helpful comments regarding gastroenterology. Finally, the writing group would like to thank Lori Hinrichs for her superb assistance with the preparation of this manuscript. |
Wilson et al Prevention of Infective Endocarditis 1749 Disclosures Writing Group Disclosures Writing Group Member Employment Research Grant Other Research Support Speakers Bureau/ Honoraria Ownership Interest Consultant/ Advisory Board Other Walter Wilson Mayo Clinic None None None None None None Larry M. Baddour Mayo ... |
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