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Infective Endocarditis (IE) and Tattooing
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Infective Endocarditis (IE) and Tattooing


Hi my name is Sam and I was born with Tetralogy of Fallot, which was corrected at a year old in 1987 at CHOP by Dr. Norwood. In my research I have found that between the years 1991-2007 there has only been 22 cases of infective endocarditis due to body art. Out of the 22 cases only one case of infective endocarditits was associated with tattoos. The lone case of infective endocarditis was a 28-year-old man with a congenital functionally bicuspid aortic valve who was tattooed monthly for a period of five years. The patient was aware of his congenital heart problem but was unaware of the evident risk of infective endocarditis due to tattooing and consequentially did not seek the proper medical advice or take any infective endocarditis antibiotic prophylaxis. My Cardiologist, though I expected this, said that the antibiotics may confer protection but one can never be too careful or certain that a mishap (infective endocarditis) may occur. When I rock climb, skydive, or surf there are variables that could cause injury or even mortality but because I am educated on the subject I can justify taking the educated risk. I cannot justify getting a tattoo if the chances of having problems with endocarditis are quite evident and substantial. Though in my research I have read that the risk of infective endocarditis is not nearly as high as initially thought to be. What I am trying to say is that I am fully aware of what infective endocarditis is and that there is a greater risk amongst patients with congenital heart defects due to dirty tattoo equipment and having an open wound susceptible to infection. What I don’t completely understand is:
                                   1) What would be the recommended antibiotic cycle when getting a tattoo?
                                   2) Is it comparable to the risk I'm taking getting my teeth cleaned or other similar procedures?
                                   3) What are other precautions other than antibiotic prophylaxis?
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Dear Sam,

It appears that you have done quite a bit of both research and thought into this matter.  In the grand scheme of things, the risk of infective endocarditis (IE) in the face of tattooing is very low, but it is not zero.  That said, there is not an antibiotic regimen (or "cycle") that is recommended for this procedure, as the American Heart Association feels that the risk associated with this is low (and is probably lower than that of having yoru teeth cleaned).  Besides ensuring that the procedure is done with sterile equipment in a location that uses sterile techniques, the most important things that you can do to reduce this risk are 1) take a shower or bath with soap that day and 2) ensure that the skin is well cleaned with some sort of surgical cleaner at the time of the placement of the tattoo.  This will significantly reduce the load of bacteria on your skin that could lead to an infection.
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