Wilson Walter, Taubert Kathryn A, Gewitz Michael, Lockhart Peter B, Baddour Larry M, Levison Matthew, Bolger Ann, Cabell Christopher H, Takahashi Masato, Baltimore Robert S, Newburger Jane W, Strom Brian L, Tani Lloyd Y, Gerber Michael, Bonow Robert O, Pallasch Thomas, Shulman Stanford T, Rowley Anne H, Burns Jane C, Ferrieri Patricia, Gardner Timothy, Goff David, Durack David T
Mayo Clinic, Rochester, MN, USA.
J Am Dent Assoc. 2007 Jun;138(6):739-45, 747-60. doi: 10.14219/jada.archive.2007.0262.
The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis, which were last published in 1997.
A writing group appointed by the AHA for their expertise in prevention and treatment of infective endocarditis (IE) with liaison members representing the American Dental Association, the Infectious Diseases Society of America and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on IE. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and IE; in vitro susceptibility data of the most common microorganisms, which cause IE; results of prophylactic studies in animal models of experimental endocarditis; and retrospective and prospective studies of prevention of IE. MEDLINE database searches from 1950 through 2006 were done for English language articles using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization and bacteremia. The reference lists of the identified articles were also searched. The writing group also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The article subsequently was reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee.
The major changes in the updated recommendations include the following. (1) The committee concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective. (2) IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE. (3) For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when IE prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
本声明旨在更新美国心脏协会（AHA）关于感染性心内膜炎预防的建议，该建议上次发布于1997年。
AHA任命了一个写作小组，其成员在感染性心内膜炎（IE）的预防和治疗方面具有专业知识，并设有代表美国牙科协会、美国传染病学会和美国儿科学会的联络成员。写作小组审查了国内外IE专家的意见。本文件中的建议反映了对有关手术相关菌血症和IE的相关文献的分析；导致IE的最常见微生物的体外药敏数据；实验性心内膜炎动物模型中预防性研究的结果；以及预防IE的回顾性和前瞻性研究。使用以下搜索词对1950年至2006年的MEDLINE数据库进行了英文文章搜索：心内膜炎、感染性心内膜炎、预防、预防措施、抗生素、抗菌药物、病原体、微生物、牙科、胃肠道、泌尿生殖道、链球菌、肠球菌、葡萄球菌、呼吸道、牙科手术、发病机制、疫苗、免疫接种和菌血症。还搜索了已识别文章的参考文献列表。写作小组还搜索了AHA在线图书馆。采用了美国心脏病学会/AHA实践指南的推荐分类和证据水平。该文章随后由与写作小组无关的外部专家以及AHA科学咨询与协调委员会进行了审查。
更新后的建议中的主要变化如下。（1）委员会得出结论，即使抗生素预防措施100%有效，通过牙科手术的抗生素预防也只能预防极少数IE病例。（2）仅应针对患有与IE不良后果风险最高相关的基础心脏疾病的患者推荐牙科手术的IE预防措施。（3）对于患有这些基础心脏疾病的患者，对于所有涉及牙龈组织或牙齿根尖区域操作或口腔黏膜穿孔的牙科手术，均建议进行预防。（4）不建议仅基于IE获得的终身风险增加而进行预防。（5）对于接受泌尿生殖道或胃肠道手术的患者，不建议仅为预防心内膜炎而使用抗生素。这些变化旨在更明确地界定何时建议或不建议进行IE预防，并提供更统一和一致的全球建议。
