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Prevention of bacterial endocarditis.

To the Editor.— Dajani et al 1 provide excellent recommendations for prophylaxis against bacterial endocarditis for dental and surgical procedures in patients at risk. I was concerned to find that urethral catheterization was listed among surgical procedures, not because catheterization is a potential risk for transient bacteremia, but because so many individuals with neurogenic bladder dysfunction are treated with intermittent catheterization. Multiple medical conditions and traumatic events result in neurogenic bladder dysfunction. Of the over 200 000 persons with spinal injuries living in the United States, it is estimated that 6% to 8% are treated with long-term intermittent catheterization. 2 Studies have shown that a significant number of these individuals' bladders are colonized with bacterial organisms, many of which are highly resistant to antibiotics and some of which are known to cause endocarditis (eg, Enterococcus species, Staphylococcus species). The levels of organisms from catheterized urine samples in asymptomatic individuals can