Chapter 7: Infectious Diseases

COLITIS, CLOSTRIDIOIDES DIFFICILE

Population

All adults.

Organizations

► ACG 2013, CID 2018

Prevention Recommendations

• – Develop antibiotic stewardship programs to minimize the frequency and duration of high-risk antibiotic therapy.

• – Place patients with suspected C. difficile infection (CDI) preemptively on contact precautions pending the C. difficile test results.

• – Maintain contact precautions for at least 48 h after diarrhea has resolved.

• – Perform hand hygiene before and after contact of a patient with CDI and after removing gloves with either soap or water.

• – Use gloves and gowns on entry to the room of a patient with known or suspected CDI and remove gowns and gloves before leaving the patient’s room.

• – Prevent transmission by using single-use disposable equipment. Thoroughly clean and disinfect reusable medical equipment, preferentially with a sporicidal disinfectant. Dedicated nondisposable equipment should be kept in the patient’s room.

• – Disinfect environmental surfaces using an Environmental Protective Agency (EPA)–registered disinfectant with C. difficile sporicidal label claim or minimum chlorine concentration of 5000 ppm.

• – Although there is an epidemiological association between proton pump inhibitor (PPI) use and CDI, there is insufficient evidence for discontinuation of PPIs as a measure for preventing CDI.

• – Although there is moderate evidence that probiotics containing Lactobacillus rhamnosus GG and Saccharomyces boulardii decrease the incidence of antibiotic-associated diarrhea, there is insufficient data to recommend administration of probiotics for primary prevention of CDI. Still, short-term use of probiotics appears to be safe and effective when used along with antibiotics in patients who are not immunocompromised or severely ill.

Sources

• – Am J Gastroenterol. 2013;108(4):478.

• – Clin Infect Dis. 2018;66(7):e1-e48.

• – Cochrane Database Syst Rev. 2017;12:CD006095.

ENDOCARDITIS, INFECTIOUS

Population

Adults at risk for infectious endocarditis.

Organizations

► AHA 2007, AHA/ACC 2014, AHA/ACC 2017, AAPD 2014

Prevention Recommendations

• – Maintain optimal oral health and hygiene. This is more important in reducing the risk of infective endocarditis (IE) than prophylactic antibiotics for dental procedures.

• – There is insufficient evidence to support the use of topical antiseptics for IE prevention.

• – Prevent rheumatic fever by promptly recognizing and treating streptococcal pharyngitis.

• – The effectiveness of antibiotic prophylaxis in preventing IE in patients undergoing dental procedures is unknown.

• – Do not use antibiotic prophylaxis for mitral valve prolapse (MVP), rheumatic heart disease (RHD), or most cases of congenital heart disease (CHD).¹

• – Offer IE prophylaxis² only for patients with underlying cardiac conditions (patients with prosthetic valves,³ previous history of IE, certain cardiac transplant recipients,⁴ and selected patients with CHD and residual defects) who will undergo selected dental, respiratory, GI, GU, skin, and soft tissue procedures.

  • Dental ...