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Infective endocarditis is a rare but severe disease, the incidence of which seems to have been stable over the past decades. Streptococci are the most frequent causative organisms. In France, infective endocarditis ranges from 25–30 cases/million inhabitants/year (about 1500 cases/year). The profile of patients presenting with infective endocarditis, though, is changing, with an increased proportion of elderly patients and a decrease of endocarditis due to oral streptococci. Valve surgery for endocarditis is performed in about one patient in two with a perioperative mortality that remains high.
Since 1992, the date of the French consensus conference on the prophylaxis of infective endocarditis, new data have been published, requiring an update of its conclusions. These new data feature the following points:
Endocarditis remains a severe disease
Bacteraemia causing infective endocarditis is probably more often related to a daily transfer of bacteria from mouth to blood than to occasional oral or dental procedures
There is no scientific proof of the efficacy, or non-efficacy, of antibiotic prophylaxis
In France, antibiotic prophylaxis is given to less than one patient in two at risk before oral or dental procedures
A broad use of antibiotic prophylaxis, supposing that it is totally efficacious, would prevent only a small number of cases in France
A worrying increase of bacteria with decreased sensitivity to antibiotics has been reported in France.
Consequently the working group suggests:
to maintain the principle of antibiotic prophylaxis when performing procedures at risk in patients with cardiac conditions at risk, but
to limit its indications to cases that have the highest ratio of individual benefit to individual and collective risk.
This is the executive summary …
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