Patient is currently under antibiotic therapy for prosthetic (bovine) valve endocarditis, CRP is almost negative, there are no vegetations and no insufficiency of the valve. Therapy will last for two more weeks. Knee replacement surgery is scheduled in four weeks. Should we wait longer? How Long?
After the complete antibiotic course, elective Knee replacement should not be a issue.
After the complete antibiotic course is done, knee replacement is elective surgery, so it shouldn't be a issue.
If there isn't any other sign of infection (fever, elevated WBC, negative blood cultures), so there is a rapid and efficient response to the actual antibiotic therapy, then an elective surgery could be performed...anyway a formal advice from an infectious disease specialist is imperative (we are talking about a prothesis implantation, the infective risk is different from any other elective surgery)! Let me know!
In any case - the prognosis of "prosthetic" endocarditis of the bioprosthetic heart valve is poor and any surgical procedure may provoke him.
However, let me know what was the basis for the diagnosis of "prosthetic" endocarditis?
Did You based on any "large" criteria (obviously, one of the "big" criteria absent - no vegetations on the valve), or on a set of "small" criteria? What exactly?
Have there been attempts to detect other foci of infection, in addition to the valve implant?
Has a procalcitonin test?
If we are talking about an infectious lesion of the bioprosthesis and successful antibiotic treatment, I would advise you to delay implantation of the knee up to 6 months.
Dear Martina Fink: The optimum is that there is no prosthetic endocarditis, once there is a big problem. It is important to insist on doing a good endocarditis prophylaxis.
In our experience at the Institute of Cardiology some patients have been resolved with antibiotic treatment and have had no need to return to undergo another operation. So that in time is possible to obtain cured by antibiotic treatment.
The best time to make a prosthetic valve replacement will be:
1-After That can stabilize general parameters.
2-After That antibiotics have adecaudas plasma concentrations.
3-He must have defined what type of prosthetic dysfunction in the patient.
It must be selected the appropriate prosthesis for each patient.
We must remember that it is not just mechanical prosthetic endocarditis a biological prosthesis.
Brotherly
Dr.Nizahel Estevez Alvarez. MD
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