Lifelong risk of infection after surgery

dudara

I had open heart surgery when I was 10 years old, over 16 years ago now. I've been told since then by dentists and doctors that I have an increased risk of septicemia (sic) or blood poisoning due to the surgery. I can't give blood due to the risk that the deep needle poses to me, and anytime I get dental work like fillings, I have to take antibiotics.

What I'd like to know is why surgery results in this increased risk?

DrIndy

You may. It is because you have had heart surgery and particularily people with artificial valves are also at risk.

The heart and its valves are perfectly formed, living dynamic tissue that repels bacteria and other matter like blood clots from attaching themselves. When the heart valve surface is damaged and due to the phenomenal flow of blood across it, there is a chance that a bacteria will encounter that surface and stick to it.

When this happens on a normal heart valve, the tissue repels it, but when damaged, it cannot. The bacteria then triggers an response which clots blood over it and when covered by a clot cannot be attacked by the immune system as it is covered by cells. The bacteria happily multiply under this coating and increase in size. they can also further erode and damage the underlying heart valve (particularily staphylococcus).

Likewise, antibiotics have great difficulty penetrating to kill the bacteria as the coating of clotted cells prevents the easy diffusion of antibiotics, which is why someone with bacterial endocarditis has to be treated with high dose intravenous antibiotics for up to 2 months in hospital.

What can happen is if the clots get big then they can break off and cause strokes or obstruct vessels. when they do so, they are not just a clot, but contain bacteria so can cause abscesses in the body. When it occurs in the brain it is very serious.

The basis of antibiotic cover during a procedure is to kill immediately any bacteria that get into the bloodstream before they have a chance to adhere to the valve surface and trigger endocarditis.

Of note, normal healthy valves in normal healthy people can spontaneously get infected too, it is not just limited to people with heart surgery although the risk is much higher.

The two chief culprits are Streptococcus which causes a slow indolent infection with small clots on the valve. The other is staphylococcus which is much more aggressive causing big clots that easily break off and also attacks the surface of the heart valve, damaging it further.

People after heart surgery tend to get streptococcus over staphylococcus.

Of additional note, on metal implants in hearts, the bacteria become a film and are covered by mucilaneous material which renders them very difficult to treat indeed once established.

I would suggest you discuss this in some detail with your GP and cardiologist of you still see him/her for the regimen you should use for procedures if indeed you need one at all (depends on the surgery). I can only comment on the process by which it occurs...

dudara

That's the first coherent explaination I've heard. Thank you very much.

As far as I know, I had a hole in the septum, not a valve, but I presume that similar logic applies to any form of damaged heart tissue.

DrIndy

Maybe, maybe not. When a doctor or dentist hears "heart surgery" we automatically err on the side of caution and use antibiotic cover just in case. This is not an automatic requirement, depending on the nature of the original surgery - but only your attending doctor can determine this. It would do no harm to ask them this so you know if you must have antibiotic cover and which kind.

btkm8unsl0w5r4

Yeah that's a good explanation above. Anywhere the blood flow in the heart is turbulant you can get a bacterial endocarditis which is a very nasty and difficult condition to treat. Also those who has Rheumatic fever (not arthritis) are at risk as this damages the heart valves also. Only some cardiac conditions require antibiotic cover before surgery and only some dental treatments (those that would shead blood and cause the forcing of bacterial into the blood. People who have Atrial septal defrects closed as children often dont require antibiotic cover except in the year following surgery. But as the good advice above states seek a cardiologists opinion as they are the only people who have the experitse to properly advise you. In this age of litigation surgeons and dentists are rightfully cautious when a patient reports a possible heart condition and the indiscriminate use of antibotics follows. Infact the number of people who died in the UK from dentally provoked endocarditis was far less than those who died due to allergy to the antibiotics given to prevent endocarditis...sigh...pardon my spelling

dudara

Infact the number of people who died in the UK from dentally provoked endocarditis was far less than those who died due to allergy to the antibiotics given to prevent endocarditi

Now you've just scared me!!

Seriously, my GP who diagnosed me has since passed away, but his son runs the practice now, so I'll ask him or my cardiologist, Dr.Frederick Woods, when I get a chance.

DrIndy

dudara wrote:

Now you've just scared me!!

Seriously, my GP who diagnosed me has since passed away, but his son runs the practice now, so I'll ask him or my cardiologist, Dr.Frederick Woods, when I get a chance.

There are 3 kinds of lies - lies, damned lies and statistics. It all comes down to interpretation. Drug allergies not rare - but they only apply to those who have never had courses of that antibiotic before and are exposed for the first time. If someone has ever had a penicillin class antibiotic without reaction then it is safe to say they are not at risk.

Ask your cardiologist - I presume you still get annual checkups? If he has a clinical nurse specialist, he/she would be a good port of first call.

btkm8unsl0w5r4

DrIndy wrote:

There are 3 kinds of lies - lies, damned lies and statistics. It all comes down to interpretation. Drug allergies not rare - but they only apply to those who have never had that antibiotic before and are exposed for the first time. If someone has ever had a penicillin class antibiotic without reaction then it is safe to say they are not at risk.

Ask your cardiologist - I presume you still get annual checkups? If he has a clinical nurse specialist, he/she would be a good port of first call.

No anaphylaxis is a type 4 hypersenstivity reaction and sensisation can happen at any time regardless of past exposure. Previously having no reaction is no guarantee of no risk. As a Doctor I am sure you knew this already though

DrIndy

Rylan Screeching Curve wrote:

No anaphylaxis is a type 4 hypersenstivity reaction and sensisation can happen at any time regardless of past exposure. Previously having no reaction is no guarantee of no risk. As a Doctor I am sure you knew this already though

I do know! penicillin class antibiotics are very commonly prescribed as apart from their allergy risk are safe and well understood drugs. Thus for any chest infection or bad tonsillitis (to name a few) those patients have received multiple courses over their lifespan and would know in general by adulthood if this was the case.

anaphylaxis crops up on its own - and has to be watched for, but it cannot be anticipated and unless the patient has a previous history - should not be any reason for not prescribing. clarification accepted, my pathology was slightly fuzzy on that one.

Likewise, statistics are often misinterpreted and thus should always be explained rather than simply stipulated.