Akpunonu Basil E, Bittar Samih, Phinney Richard C, Taleb Mohammed
Department of Internal Medicine, Ruppert Health Center, University of Toledo, Toledo, OH, USA.
Geriatrics. 2008 Aug;63(8):12-9.
Infective endocarditis (IE) is becoming a disease of the elderly because of the aging process and increased use of intravascular devices. If undetected, IE has a poor prognosis. Previous guidelines had become cumbersome, and with unintended consequences, ie, excess antibiotic use, potential risk for acquisition of multiple-drug-resistant organisms and adverse drug reactions. The newest American Heart Association guideline severely restricts antibiotic prophylaxis, recommending it only for cardiac conditions with the greatest risks for complications and for dental procedures that involve perforation of oral mucosa, manipulation of gingival tissue or periapical region of the teeth. Routine prophylaxis for genitourinary and gastrointestinal procedures is no longer recommended.
由于老龄化进程以及血管内装置使用的增加，感染性心内膜炎（IE）正成为一种多见于老年人的疾病。如果未被发现，IE的预后较差。以往的指南变得繁琐，并且产生了意想不到的后果，即抗生素过度使用、获得多重耐药菌的潜在风险以及药物不良反应。美国心脏协会最新指南严格限制抗生素预防，仅推荐用于并发症风险最高的心脏疾病以及涉及口腔黏膜穿孔、牙龈组织或牙齿根尖周区域操作的牙科手术。不再推荐对泌尿生殖系统和胃肠道手术进行常规预防。
