Περιοχές ενδιαφέροντος Ενδοκαρδίτιδα Ρευματικός πυρετός Εμβολιασμοί (γρίπης, πνευμονιοκόκκου) Προφύλαξη για RSV Υγιεινή χεριών

Infective endocarditis Abx prophylaxis for the highest risk pts Good oral hygiene & regular dental review more important than Abx prophylaxis Aseptic measures during any invasive procedure ESC 2015 ESC 2015

OPTIMAL ORAL CARE

Highest risk procedures Dental when gingival manipulation, perforation NO for respiratory, gastro/colonoscopy, cystoscopy, ob/gyn, skin & soft tissue ESC 2015

Highest risk for IE Annuloplasty rings & chords Cardiac transplant with valve regurgitation due to a structurally abnormal valve Cardiac transplant with valve regurgitation due to a structurally abnormal valve AHA 2017

Abx for IE prevention ESC 2015

Abx for IE prevention Mackie AS et al. 2016:1-7

Abx for IE prevention ESC 2015 Lancet. 2015 Mar 28; 385(9974): 1219-28

Abx for IE prevention ESC 2015

Non specific prevention Dental Wounds Bacterial carriage, e.g. MRSA Abx for infection, eliminate sepsis-> bf foreign material No piercing/tattooing Limit infusion catheters/invasive procedures ESC 2015

Rheumatic fever 1ry prophylaxis -> Rx of acute strep pharyngitis previous documented RF or those w RHD specifically MS GAS prevention & new rheumatic episodes Benzathine PCN im Q21 days efficacious but painful Alt PCN V, azithro AHA 2009

RF – duration of chemoprophylaxis NO rheumatic carditis 5yrs after acute RF or until age 21 - whichever longer J Am Coll Cardiol 63:e57, 2014

RF – duration of chemoprophylaxis Carditis without residual heart disease -> 10 yrs after acute RF or till age 21 - whichever longer J Am Coll Cardiol 63:e57, 2014

RF – duration of chemoprophylaxis Carditis w residual heart disease 10 yrs since last episode or till age 40 - whichever longer J Am Coll Cardiol 63:e57, 2014

RF prevention

Εμβολιασμοί Γρίπης & σε μέλη οικογενείας Πνευμονιοκόκκου Άλλοι  κίνδυνος εισαγωγής σε νοσοκομείο, ΜΕΘ, θανάτου Πνευμονιοκόκκου Άλλοι Ζωστήρα

Λειτουργία σπλήνα-heterotaxy PCV vaccination, Abx – 5yrs of age Abdominal U/S, CT, MRI Blood smear for Howell-Jolly RBCs quantification by interference contrast microscopy Heat damaged Tc-99 labelled RBC scan

Howell-Jolly

Υγιεινή χεριών Ιδιαίτερα σημαντική σε εξωτερικά καρδιολογικά ιατρεία και σε καρδιολογικές κλινικές στο νοσοκομείο

Hand hygiene-WHO 5 moments

HAI - AMR

HAI - AMR

HAI - AMR

CLABSI prevention 4 κύριες οδοί Skin colonization Intraluminal or hub 2ry seeding from BSI Contaminated infusate CID 2002;34:1232-1242

CLABSI bundle, checklists

Prediction of degree of benefit from ICD implantation Balance of Risk vs benefit Sudden Death from Ventricular Arrhythmia Non-Sudden Death Procedural Risk Inappropriate shocks Device infection

CCS 2016

CCS 2016

Προφύλαξη για RSV Palivizumab σε νεογνά & παιδιά < 24 μηνών με Αιμοδυναμικά σημαντική κυανωτική ή μη CHD Περιλαμβάνει ασθενείς με CHF & PHTN  hospitalization for RSV

Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest Resuscitation. 2017 Feb;111:103-109.

Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest Resuscitation. 2017 Feb;111:103-109.

Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest 28% aspiration No difference in outcome postresuscitation pneumonia, ICU treatment and outcome Resuscitation. 2017 Feb;111:103-109.

ΣΥΜΠΕΡΑΣΜΑΤΑ Abx σε high risk condition για ΙΕ, καλή υγιεινή στόματος Εμβολιασμοί ασθενών & προσωπικού Υγιεινή χεριών CLABSI bundle ΠΡΟΣΟΧΗ στην σωστή χρήση Αβχ