BACTERIAL ENDOCARDITIS

Bacterial infection of heart-valves, usually previously damaged by rheumatic fever or another disease process, features regularly in prospective medical negligence claims.

Rheumatic fever is far less prevalent than in previous generations. Bacterial Endocarditis is now affecting an older population (median age 50), some of whom are infected during invasive medical investigations such as cardiac catheterisation, but there is a significant contribution from intravenous drug abuse[1].

A mail questionnaire revealed that only one-third of both dental and medical practitioners followed the American Heart Association guidelines on antibiotic prophylaxis of Bacterial Endocarditis[2]. Conversely, a prospective study in the Netherlands showed that stricter adherence before dental procedures might have prevented only one in twenty cases[3].

PRACTICE POINT Negligence in preventing Bacterial Endocarditis is difficult to prove

Symptoms of bacterial endocarditis are frequently nonspecific. Early studies found that between a quarter[4] and a half[5] of an unselected series of patients had puzzling rheumatic complaints during the weeks preceding diagnosis.

Diagnostic delay of a few to many weeks is standard, but certain symptoms mandate definitive investigation including White Blood Cell Count and Blood Cultures. In the presence of fever of unknown origin, newly appearing or changing heart murmurs require the competent physician to exclude this potentially serious diagnosis[1].

PRACTICE POINT Delay of weeks before diagnosis is not in itself substandard

Even with prompt diagnosis and appropriate treatment, serious complications may continue to progress[6] and the mortality rate is still as high as 25%[7].

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