Particularities of infective endocarditis prophylaxis in Republic of Moldova

Abstract

The aim of the paper was to determine whether adults from increased risk groups have adequate knowledge of infective endocarditis (IE) and to evaluate the particularities of infective endocarditis prophylaxis in comparison to the recent tendencies recommended by the international guidelines. We evaluated 133 patients (33 with IE, 80 with rheumatic heart disease and 20 with congenital heart disease) divided in two groups: i) High risk group included 33 pt. with IE, 31 pt. with valve prosthesis and 17 with congenital heart diseases (tetralogy of Fallot, ventricular septal defect, aortic coarctation, bicuspid aortic valve) ii) Moderate risk group was formed by patients with rheumatic heart disease without prosthesis and congenital heart diseases such as aortic stenosis and prolapse of the mitral valve. We asked selected patients and 50 doctors responsible for infective endocarditis treatment and prevention (cardiologists, family doctors and dentists) to complete a 10-question survey to assess their knowledge of heart disease, infective endocarditis, and endocarditis prophylaxis. Out of 133 patients (100%), 102 patients knew the name of their heart disease. Fifty patients correctly defined endocarditis, but only 38 knew hygiene measures that could prevent endocarditis. Thirty patients knew that they needed to take "a medicine" before dental procedures and just 18 of those patients knew that an antibiotic was necessary. Among doctors, all knew what infective endocarditis is, but 30% of family doctors and 67% of dentists hesitated to name the antibiotic of choice and its dosage. The most recent guidelines recommend prophylaxis only in patients with underlying cardiac conditions with the higher risk of adverse outcomes, including patients with a previous history of infective endocarditis, patients with prosthetic heart valve or prosthetic material used for valve repair, patients with a valvulopathy after cardiac transplantation, and patients with a specific congenital heart disease. But it is a particularity of Moldova that the number of patients with rheumatic valve disease is high, that is why we consider forming a group of moderate risk for infective endocarditis and to include them in prophylaxis regimens. Many adults with heart diseases have inadequate knowledge of their cardiac lesion, of endocarditis and of endocarditis prophylaxis. Educational efforts for them need to be updated and reinforced regularly. The use of definite criteria for identifying groups of risk and prescribing antibiotics regiments for IE prophylaxis can decrease its incidence and rate of complications.