Castillo Eliana, Magee Laura A, von Dadelszen Peter, Money Deborah, Blondel-Hill Edith, van Schalkwyk Julie
Department of Medicine, University of British Columbia, Vancouver BC; Children's and Women's Health Centre of British Columbia, Vancouver BC.
Department of Medicine, University of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, Child and Family Research Institute, University of British Columbia, Vancouver BC; Women's Health Research Institute, Vancouver BC.
J Obstet Gynaecol Can. 2008 Sep;30(9):796-799. doi: 10.1016/S1701-2163(16)32944-9.
The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis. Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and/or gynaecological procedures, not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis. This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from "randomly occurring" bacteremia (e.g., from brushing teeth) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective. A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implications is presented.
2007年美国心脏协会预防感染性心内膜炎指南显著减少了符合预防性用药的手术类型以及需要预防性用药的心脏病变类型。对于任何接受产科和/或妇科手术的患者，甚至是患有心脏病变且发生感染性心内膜炎并发症风险最高的患者，均不建议使用抗生素预防感染性心内膜炎。这与先前发布的指南有很大不同，其依据是认识到感染性心内膜炎更可能由“随机发生”的菌血症（如刷牙引起）而非侵入性手术引起，且抗生素预防的有效性尚未得到证实。本文简要讨论了与产科和妇科手术相关的肠球菌感染及其治疗意义。
