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Prevention of Bacterial Endocarditis: American Heart Association Recommendations-Reply

Adnan S. Dajani, MD; Ann F. Bolger, MD; Kathryn A. Taubert, PhD
JAMA. 1997;278(15):1233. doi:10.1001/jama.1997.03550150037024.
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In Reply.  —Dr Park's comments regarding "surgically scrubbed skin" implies properly cleansed skin before a procedure is performed. Skin cannot be "sterilized," whether the procedure is done in an operating room setting or in an outpatient office setting. We hope that skin preparation is adequate in any setting. The recommendations in the reference1 cited by Park subsequently were challenged by a letter to the editor.2 The organisms that reside on noninfected skin are not commonly associated with endocarditis, and bacteremia following procedures performed through scrubbed skin is not likely. For these reasons, we do not recommend prophylaxis under these circumstances. Procedures involving infected tissues may result in bacteremia, and we provided recommendations for this situation in our article. Dr Singer raises a somewhat related issue. For the reasons mentioned above, clean, noninfected lacerations do not require routine prophylaxis.Dr Cheng points out areas of uncertainty regarding patients with a history


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