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2007, Número 4

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Rev ADM 2007; 64 (4)


Prevención de endocarditis infecciosa. Guías de la American Heart Association

Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT

Idioma: Español
Referencias bibliográficas: 154
Paginas: 131-157
Archivo PDF: 203.13 Kb.


RESUMEN

Antecedentes. El propósito de esta iniciativa es actualizar las recomendaciones de la American Heart Association (AHA) para la prevención de endocarditis infecciosa, publicada en 1997.
Métodos y resultados. Un grupo de redacción fue nombrado por la AHA por su experiencia en la prevención y tratamiento de la endocarditis infecciosa, con participación de miembros de la American Dental Association, la Infectious Diseases Society of America y la American Academy of Pediatrics. El grupo revisó las contribuciones de expertos nacionales e internacionales en endocarditis infecciosa. Las recomendaciones de este documento reflejan el análisis de la literatura relevante en relación con la bacteremia secundaria a procedimientos y la endocarditis infecciosa, datos de susceptibilidad in vitro de los organismos que más comúnmente causan endocarditis, resultados de estudios profilácticos en modelos animales de endocarditis experimental y estudios prospectivos y retrospectivos de prevención de endocarditis infecciosa. Se realizó una búsqueda en MEDLINE de 1950 a 2006 de artículos en idioma inglés utilizando los siguientes términos: endocarditis, endocarditis infecciosa, profilaxis, prevención, antibiótico, antimicrobiano, patógenos, organismos, dental, gastrointestinal, genitourinario, Streptococcus, Enterococcus, Staphylococcus, respiratorio, cirugía dental, patogénesis, vacunas, inmunización y bacteremia. Las listas de las referencias de los artículos identificados también se incluyeron en la búsqueda. También se realizó la búsqueda en la librería en línea de la AHA. Se utilizó la clasificación de recomendaciones y los niveles de evidencia para guías de práctica clínica del American College of Cardiology/AHA. Este artículo fue revisado posteriormente por expertos externos no afiliados con el grupo de trabajo y por el AHA Science Advisory and Coordinating Committee.
Conclusiones. Los cambios mayores en las recomendaciones actualizadas incluyen lo siguiente: (1) El Comité concluyó que solamente un número muy pequeño de casos de endocarditis infecciosa se pueden prevenir mediante profilaxis con antibióticos para procedimientos dentales, aun cuando el 100% de la terapia profiláctica fuese 100% efectiva. (2) La profilaxis de endocarditis infecciosa para procedimientos dentales debe ser recomendada únicamente para pacientes con condiciones cardiacas subyacentes, asociadas con el riesgo más alto de resultados adversos de endocarditis infecciosa. (3) Para pacientes con estas condiciones cardiacas subyacentes la profilaxis es recomendada para todos los procedimientos dentales que requieren de manipulación del tejido gingival o de la región periapical de los dientes o perforación de la mucosa oral. (4) La profilaxis no se recomienda en base únicamente a un riesgo permanente de padecer endocarditis infecciosa. (5) La administración de antibióticos únicamente para prevenir endocarditis no es recomendada para pacientes que se someterán a procedimientos de los tractos genitourinario o gastrointestinal. Estos cambios están orientados a definir con mayor claridad cuándo la profilaxis para la endocarditis infecciosa es o no es recomendada y para proporcionar recomendaciones globales uniformes y consistentes.


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