1
|
Bergadà-Pijuan J, Frank M, Boroumand S, Hovaguimian F, Mestres CA, Bauernschmitt R, Carrel T, Stadlinger B, Ruschitzka F, Zinkernagel AS, Kouyos RD, Hasse B. Antibiotic prophylaxis before dental procedures to prevent infective endocarditis: a systematic review. Infection 2023; 51:47-59. [PMID: 35972680 PMCID: PMC9879842 DOI: 10.1007/s15010-022-01900-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE. METHODS We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol. RESULTS The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered. CONCLUSIONS Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.
Collapse
Affiliation(s)
- Judith Bergadà-Pijuan
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Boroumand
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frédérique Hovaguimian
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Carlos A. Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Bauernschmitt
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Roger D. Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
2
|
Rutherford SJ, Glenny AM, Roberts G, Hooper L, Worthington HV. Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures. Cochrane Database Syst Rev 2022; 5:CD003813. [PMID: 35536541 PMCID: PMC9088886 DOI: 10.1002/14651858.cd003813.pub5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infective endocarditis is a severe infection arising in the lining of the chambers of the heart. It can be caused by fungi, but most often is caused by bacteria. Many dental procedures cause bacteraemia, which could lead to bacterial endocarditis in a small proportion of people. The incidence of bacterial endocarditis is low, but it has a high mortality rate. Guidelines in many countries have recommended that antibiotics be administered to people at high risk of endocarditis prior to invasive dental procedures. However, guidance by the National Institute for Health and Care Excellence (NICE) in England and Wales states that antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. This is an update of a review that we first conducted in 2004 and last updated in 2013. OBJECTIVES Primary objective To determine whether prophylactic antibiotic administration, compared to no antibiotic administration or placebo, before invasive dental procedures in people at risk or at high risk of bacterial endocarditis, influences mortality, serious illness or the incidence of endocarditis. Secondary objectives To determine whether the effect of dental antibiotic prophylaxis differs in people with different cardiac conditions predisposing them to increased risk of endocarditis, and in people undergoing different high risk dental procedures. Harms Had we foundno evidence from randomised controlled trials or cohort studies on whether prophylactic antibiotics affected mortality or serious illness, and we had found evidence from these or case-control studies suggesting that prophylaxis with antibiotics reduced the incidence of endocarditis, then we would also have assessed whether the harms of prophylaxis with single antibiotic doses, such as with penicillin (amoxicillin 2 g or 3 g) before invasive dental procedures, compared with no antibiotic or placebo, equalled the benefits in prevention of endocarditis in people at high risk of this disease. SEARCH METHODS An information specialist searched four bibliographic databases up to 10 May 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: Due to the low incidence of bacterial endocarditis, we anticipated that few if any trials would be located. For this reason, we included cohort and case-control studies with suitably matched control or comparison groups. The intervention was antibiotic prophylaxis, compared to no antibiotic prophylaxis or placebo, before a dental procedure in people with an increased risk of bacterial endocarditis. Cohort studies would need to follow at-risk individuals and assess outcomes following any invasive dental procedures, grouping participants according to whether or not they had received prophylaxis. Case-control studies would need to match people who had developed endocarditis after undergoing an invasive dental procedure (and who were known to be at increased risk before undergoing the procedure) with those at similar risk who had not developed endocarditis. Our outcomes of interest were mortality or serious adverse events requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse effects of the antibiotics; and the cost of antibiotic provision compared to that of caring for patients who developed endocarditis. DATA COLLECTION AND ANALYSIS Two review authors independently screened search records, selected studies for inclusion, assessed the risk of bias in the included study and extracted data from the included study. As an author team, we judged the certainty of the evidence identified for the main comparison and key outcomes using GRADE criteria. We presented the main results in a summary of findings table. MAIN RESULTS Our new search did not find any new studies for inclusion since the last version of the review in 2013. No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included in the previous versions of the review, but one case-control study met the inclusion criteria. The trial authors collected information on 48 people who had contracted bacterial endocarditis over a specific two-year period and had undergone a medical or dental procedure with an indication for prophylaxis within the past 180 days. These people were matched to a similar group of people who had not contracted bacterial endocarditis. All study participants had undergone an invasive medical or dental procedure. The two groups were compared to establish whether those who had received preventive antibiotics (penicillin) were less likely to have developed endocarditis. The authors found no significant effect of penicillin prophylaxis on the incidence of endocarditis. No data on other outcomes were reported. The level of certainty we have about the evidence is very low. AUTHORS' CONCLUSIONS There remains no clear evidence about whether antibiotic prophylaxis is effective or ineffective against bacterial endocarditis in at-risk people who are about to undergo an invasive dental procedure. We cannot determine whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically, practitioners should discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
Collapse
Affiliation(s)
- Samantha J Rutherford
- Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, Dundee, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Aragoneses JM, Aragoneses J, Brugal VA, Algar J, Suarez A. Evaluation of the Current Knowledge About Bacterial Endocarditis Prevention Among General Dentists in the City of Santo Domingo, Dominican Republic. Front Public Health 2020; 8:585332. [PMID: 33330328 PMCID: PMC7732663 DOI: 10.3389/fpubh.2020.585332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease caused by bacterial adherence to the lining of the heart and heart valve, and it can be caused by bacterial contamination of the bloodstream during invasive dental procedures. The American Heart Association (AHA) recommended guidelines for antibiotic prophylaxis in 2008 before invasive dental procedures; however, in the Dominican Republic, no official guidelines or regulations on this topic have been yet established. This study aimed to evaluate the current knowledge about bacterial endocarditis prevention among dentists in Santo Domingo. The study participants were dentists who attended a conference organized by Universidad Federico Henríquez y Carvajal (n = 95), of which 74 responded to the questionnaire survey. Seventy-eight percentage of the participants responded that an indication of antibiotics is recommended in cases of prophylaxis for IE. The prescription of antibiotics was applied to patients with prosthetic valves (78.4%), presented a history of previous IE (77%) among others. Among all the interventions in which the respondents would prescribe antibiotics, tooth extraction (70.7%) was the most frequent. Amoxicillin was the preferred drug choice (63.5%) and clindamycin was the antibiotic of choice in allergic patients (55.4%). Even though the choice of antibiotics were according to AHA guidelines (2008), majority of the dentists (58.82 and 55.4%) were not aware of the correct dosage and timing of administration of azithromycin and clindamycin in drugs in patients allergic to penicillin.
Collapse
Affiliation(s)
- Juan Manuel Aragoneses
- Department of Dental Research, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Javier Aragoneses
- Department of Dentistry, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Vanessa Arlette Brugal
- Department of Pediatric Dentistry and Orthopedics, School of Dentistry, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Suarez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| |
Collapse
|
4
|
Dijkstra GW, Glaudemans AWJM, Erba PA, Wouthuyzen-Bakker M, Sinha B, Vállez García D, van der Sluis LWM, Slart RHJA. Relationship between 18F-FDG Uptake in the Oral Cavity, Recent Dental Treatments, and Oral Inflammation or Infection: A Retrospective Study of Patients with Suspected Endocarditis. Diagnostics (Basel) 2020; 10:E625. [PMID: 32846896 PMCID: PMC7555096 DOI: 10.3390/diagnostics10090625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
[18F]-fluorodeoxyglucose positron emission tomography ([18F]FDG PET/CT) has proven to be a useful diagnostic tool in patients with suspected infective endocarditis (IE), but is conflicting in relation to dental procedures. QUESTIONS Is there a correlation between [18F]FDG PET/CT findings, recent dental treatment, and an affected oral cavity? (2) Is there a correlation between infective endocarditis (IE), oral health status, and (extra)cardiac findings on [18F]FDG PET/CT? METHODS This retrospective study included 52 patients. All [18F]FDG PET/CT scans were examined visually by pattern recognition using a three-point scale and semi-quantified within the volume of interest (VOI) using SUVmax. RESULTS 19 patients were diagnosed with IE (group 1), 14 with possible IE (group 2), and 19 without IE based on the modified Duke criteria (group 3). No correlation was found between visual PET and SUVmax and sites of oral inflammation and infection. The visual PET scores and SUVmax were not significantly different between all groups. A significant difference in the SUVmax of the valve between all groups was observed. CONCLUSIONS This study suggests that no correlation exists between the PET findings in the oral cavity and dental treatments or inflammation/infection. No correlation between IE, actual oral health status, and extra-cardiac findings was demonstrated. Additional research is needed to conclude whether [18F]FDG PET/CT imaging is a reliable diagnostic modality for oral inflammation and infection sites.
Collapse
Affiliation(s)
- Geertruida W. Dijkstra
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (G.W.D.); (L.W.M.v.d.S.)
| | - Andor W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
| | - Paola A. Erba
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
- Department of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56128 Pisa, Italy
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (M.W.-B.); (B.S.)
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (M.W.-B.); (B.S.)
| | - David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
| | - Luc W. M. van der Sluis
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (G.W.D.); (L.W.M.v.d.S.)
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
- Department of Biomedical Photonic Imaging, University of Twente, 7522 NB Enschede, The Netherlands
| |
Collapse
|
5
|
Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, Krüger Weiner C, Naimi-Akbar A. Incidence of infective endocarditis caused by viridans group streptococci in Sweden - effect of cessation of antibiotic prophylaxis in dentistry for risk individuals. J Oral Microbiol 2020; 12:1768342. [PMID: 33014311 PMCID: PMC7520904 DOI: 10.1080/20002297.2020.1768342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction In October 2012, the Swedish Medical Products Agency published new recommendations for the cessation of prophylactic antibiotics in dentistry for the prevention of infective endocarditis (IE). Previously, 2 g of amoxicillin per os would be administered 1 h before invasive dental procedures to patients with valve prosthesis, complicated heart valve disease, and to those with previous endocarditis. Objectives The aim of this study was to evaluate whether the total incidence of IE caused by oral viridans group streptococci (VGS) or IE caused by staphylococci, increased in Sweden after the introduction of the new recommendations. Methods The incidence of IE in Sweden before and after October 2012 was calculated and compared using an interrupted time series analysis. Separate analyses were conducted for the total incidence of IE, and IE caused by VGS or Staphylococcus aureus. Cases of IE were identified using the Swedish national registry of IE, which has existed since 1995 and contains data from all Swedish hospital clinics specialising in infectious disease. All cases with hospital admission date from the 1st of Jan 2008, to the 31st of Dec 2017 were included. The incidence calculations were corrected for annual changes in population size using data from the Swedish government agency Statistics Sweden. Results The results show no statistically significant increase in the slope of the trend line of the total incidence of IE, IE caused by VGS or S. aureus in the Swedish general population after October 2012, compared to before. Conclusion The results suggest that the recommended cessation of prophylactic antibiotics for the prevention of IE in dentistry has not led to an increased incidence of IE caused by oral streptococci among the Swedish population.
Collapse
Affiliation(s)
- Niko Vähäsarja
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukelands University Hospital, Bergen, Norway
| | - Anders Ternhag
- Department of Medicine Solna, Karolinska Institutet, Unit for Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Götrick
- Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Sweden
| | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Carina Krüger Weiner
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet
| | - Aron Naimi-Akbar
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet.,Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
| |
Collapse
|
6
|
Antibiotic prophylaxis of infective endocarditis in oral and maxillofacial surgery: incomplete implementation of guidelines in everyday clinical practice. Int J Oral Maxillofac Surg 2020; 49:522-528. [DOI: 10.1016/j.ijom.2019.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/12/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
|
7
|
Savadi N, Barati O, Mirhadi H, Golkari A. Designing a customized clinical practice guideline regarding antibiotic prophylaxis for Iranian general dentists. BMC Oral Health 2019; 19:217. [PMID: 31590651 PMCID: PMC6781348 DOI: 10.1186/s12903-019-0905-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Clinical practice guidelines produced by developed countries seemed to be not completely feasible for developing countries due to their different local context. In this study, we designed a customized guideline about antibiotic prophylaxis before dental procedures for Iranian general dentists. Methods This study was conducted of two parts, including a qualitative part and a cross-sectional analytic part. A multidisciplinary team searched for related guidelines and other documents, selected the most updated and high quality ones, customized their recommendations based on available antibiotics in Iran, prepared a draft adapted guideline and summarized its recommendations in 3 flowcharts. An expert panel (20 specialists of four Iranian dental universities) participated in a consensus process, afterwards to determine the relevance and clarity of the flowcharts and their items. Then the Content Validity Indices (CVIs) were calculated and any items with CVI higher than 0.79 remained. Results The adapted recommendations were summarized in flowcharts A to C. Two separate groups of patients who need antibiotic prophylaxis were presented in flowchart A; including those with high risk for distant-site infection (infective endocarditis and prosthetic joint infection) and those at risk for poor healing and orofacial infection (due to impaired immunologic function). Flowcharts B and C described antibiotic regimen and also the dental procedures where antibiotic prophylaxis was needed for mentioned groups. The content validity indices and the percentages of agreement between the expert panel members were considerably high. Conclusions A localized, clear and straight forward guideline that addresses all groups of dental patients who need antibiotic prophylaxis has been produced for Iranian general dentists. Supplementary information Supplementary information accompanies this paper at 10.1186/s12903-019-0905-3.
Collapse
Affiliation(s)
- Najmeh Savadi
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Ghasrdasht Street, Shiraz, 71956-15878, Iran.
| | - Omid Barati
- Education and Development Center, Health Human Resources Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Mirhadi
- Department of Endodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Golkari
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Ghasrdasht Street, Shiraz, 71956-15878, Iran
| |
Collapse
|
8
|
Massoth C, Zarbock A, Wenk M. [Non-cardiac surgery in adults with congenital heart defects : Most important parameters in anesthesia management]. Anaesthesist 2019; 68:245-258. [PMID: 30911773 DOI: 10.1007/s00101-019-0575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with congenital heart disease (CHD) represent an increasing proportion of patients undergoing non-cardiac surgery. OBJECTIVE To identify the most important parameters for management of anesthesia. MATERIAL AND METHODS Evaluation and discussion of the current original research and guideline recommendations. RESULTS There are approximately 300,000 patients with CHD living in Germany. The preoperative evaluation is an important influencing factor affecting perioperative morbidity and mortality. Echocardiography is the key instrument for identifying cardiac conditions predisposing to adverse events. The subdivision of CHD into lesions with left-to-right shunt, obstructive lesions and complex congenital heart diseases facilitates the classification of the pathophysiology. CONCLUSION Decisive for the perioperative outcome of patients with CHD are the identification of high-risk patients, understanding of the individual situation with respect to the underlying pathophysiology and the intraoperative maintenance of cardiac output.
Collapse
Affiliation(s)
| | | | - M Wenk
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland.
| |
Collapse
|
9
|
Ierano C, Nankervis JAM, James R, Rajkhowa A, Peel T, Thursky K. Surgical antimicrobial prophylaxis. Aust Prescr 2017; 40:225-229. [PMID: 29377021 DOI: 10.18773/austprescr.2017.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Courtney Ierano
- National Centre for Antimicrobial Stewardship, Doherty Institute, Royal Melbourne Hospital/University of Melbourne
| | | | - Rod James
- National Centre for Antimicrobial Stewardship, Doherty Institute, Royal Melbourne Hospital/University of Melbourne
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Doherty Institute, Royal Melbourne Hospital/University of Melbourne
| | - Trisha Peel
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne
| |
Collapse
|
10
|
|
11
|
Tubiana S, Blotière PO, Hoen B, Lesclous P, Millot S, Rudant J, Weill A, Coste J, Alla F, Duval X. Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: nationwide population based cohort and a case crossover study. BMJ 2017; 358:j3776. [PMID: 28882817 PMCID: PMC5588045 DOI: 10.1136/bmj.j3776] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves.Design Nationwide population based cohort and a case crossover study.Setting French national health insurance administrative data linked with the national hospital discharge database.Participants All adults aged more than 18 years, living in France, with medical procedure codes for positioning or replacement of prosthetic heart valves between July 2008 and July 2014.Main outcome measures Oral streptococcal infective endocarditis was identified using primary discharge diagnosis codes. In the cohort study, Poisson regression models were performed to estimate the rate of oral streptococcal infective endocarditis during the three month period after invasive dental procedures compared with non-exposure periods. In the case crossover study, conditional logistic regression models calculated the odds ratio and 95% confidence intervals comparing exposure to invasive dental procedures during the three month period preceding oral streptococcal infective endocarditis (case period) with three earlier control periods.Results The cohort included 138 876 adults with prosthetic heart valves (285 034 person years); 69 303 (49.9%) underwent at least one dental procedure. Among the 396 615 dental procedures performed, 103 463 (26.0%) were invasive and therefore presented an indication for antibiotic prophylaxis, which was performed in 52 280 (50.1%). With a median follow-up of 1.7 years, 267 people developed infective endocarditis associated with oral streptococci (incidence rate 93.7 per 100 000 person years, 95% confidence interval 82.4 to 104.9). Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure (relative rate 1.25, 95% confidence interval 0.82 to 1.82; P=0.26) and after an invasive dental procedure without antibiotic prophylaxis (1.57, 0.90 to 2.53; P=0.08). In the case crossover analysis, exposure to invasive dental procedures was more frequent during case periods than during matched control periods (5.1% v 3.2%; odds ratio 1.66, 95% confidence interval 1.05 to 2.63; P=0.03).Conclusion Invasive dental procedures may contribute to the development of infective endocarditis in adults with prosthetic heart valves.
Collapse
Affiliation(s)
- Sarah Tubiana
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; INSERM CIC-1425, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
- Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France
| | - Pierre-Olivier Blotière
- Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France
| | - Bruno Hoen
- Service de Maladies Infectieuses et Tropicales et Inserm-CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France; Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Pointe-à-Pitre, Guadeloupe, France
| | - Philippe Lesclous
- INSERM, U 1229, RMeS, Nantes, France, UFR d'Odontologie, Université de Nantes, Nantes, France, CHU Hôtel Dieu, Nantes, France
| | - Sarah Millot
- Department of Odontology, CHRU Université de Montpellier, France; UMR 1149 INSERM, CRI. Université Paris Diderot, France
| | - Jérémie Rudant
- Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France
| | - Alain Weill
- Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France
| | - Joel Coste
- Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France
| | - François Alla
- Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France
| | - Xavier Duval
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; INSERM CIC-1425, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| |
Collapse
|
12
|
Duval X, Millot S, Chirouze C, Selton-Suty C, Moby V, Tattevin P, Strady C, Euvrard E, Agrinier N, Thomas D, Hoen B, Alla F. Oral Streptococcal Endocarditis, Oral Hygiene Habits, and Recent Dental Procedures: A Case-Control Study. Clin Infect Dis 2017; 64:1678-1685. [PMID: 28369398 PMCID: PMC5654726 DOI: 10.1093/cid/cix237] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND. We aimed to compare oral hygiene habits, orodental status, and dental procedures in patients with infective endocarditis (IE) according to whether the IE-causing microorganism originated in the oral cavity. METHODS. We conducted an assessor-blinded case-control study in 6 French tertiary-care hospitals. Oral hygiene habits were recorded using a self-administered questionnaire. Orodental status was analyzed by trained dental practitioners blinded to the microorganism, using standardized clinical examination and dental panoramic tomography. History of dental procedures was obtained through patient and dentist interviews. Microorganisms were categorized as oral streptococci or nonoral pathogens using an expert-validated list kept confidential during the course of the study. Cases and controls had definite IE caused either by oral streptococci or nonoral pathogens, respectively. Participants were enrolled between May 2008 and January 2013. RESULTS. Cases (n = 73) were more likely than controls (n = 192) to be aged <65 years (odds ratio [OR], 2.85; 95% CI, 1.41-5.76), to be female (OR, 2.62; 95% CI, 1.20-5.74), to have native valve disease (OR, 2.44; 95% CI, 1.16-5.13), to use toothpicks, dental water jet, interdental brush, and/or dental floss (OR, 3.48; 95% CI, 1.30-9.32), and to have had dental procedures during the prior 3 months (OR, 3.31; 95% CI, 1.18-9.29), whereas they were less likely to brush teeth after meals. The presence of gingival inflammation, calculus, and infectious dental diseases did not significantly differ between groups. CONCLUSIONS. Patients with IE caused by oral streptococci differ from patients with IE caused by nonoral pathogens regarding background characteristics, oral hygiene habits, and recent dental procedures, but not current orodental status.
Collapse
Affiliation(s)
- Xavier Duval
- CIC1425 - Bichat [AP-HP Hôpital Bichat - Claude Bernard]
Université Paris Diderot - Paris 7 - AP-HP Hôpital Bichat - Claude-Bernard [Paris] -
- UFR médecine - Bichat
Université Paris Diderot - Paris 7 - PRES Sorbonne Paris Cité -
- IAME, Infection, Antimicrobiens, Modélisation, Evolution
Université Paris Diderot - Paris 7 - Université Paris 13 - Université Sorbonne Paris Cité - Institut National de la Santé et de la Recherche Médicale - U1137Faculté de médecine Paris Diderot Paris 7 - site Bichat - 16 rue Henri Huchard 75890 Paris Cedex 18
| | - Sarah Millot
- UFR médecine - Bichat
Université Paris Diderot - Paris 7 - PRES Sorbonne Paris Cité -
- Centre de Recherche sur l'Inflamation - UMR 1149
Université Paris Diderot - Paris 7 - Institut National de la Santé et de la Recherche Médicale - UMR1149Faculté de Médecine Paris Diderot Paris 7 - site Bichat16 rue Henri Huchard 75890 Paris Cedex 18
| | - Catherine Chirouze
- LCE, Laboratoire Chrono-Environnement
Université Bourgogne Franche-Comté - Centre National de la Recherche Scientifique - UMR6249Université de Franche-Comté - UFR Sciences et Techniques - 16, route de Gray - 25030 Besançon Cedex
- Service des Maladies Infectieuses et Tropicales
Centre Hospitalier Régional Universitaire [Besançon] - Hôpital Saint-Jacques - 2 place Saint-Jacques 25000 Besançon
| | | | - Vanessa Moby
- Service d'Odontologie [CHU Nancy]
Centre Hospitalier Régional Universitaire de Nancy -
| | - Pierre Tattevin
- Service des Maladies Infectieuses et Réanimation Médicale
Université de Rennes 1 - Hôpital Pontchaillou - 2 rue Henri Le Guilloux 35033 RENNES Cedex 9
| | | | - Edouard Euvrard
- Centre d'Investigation Clinique CIC-1431
Centre Hospitalier Régional Universitaire [Besançon] -
- CHRU Besançon, Centre Hospitalier Régional Universitaire [Besançon]
| | - Nelly Agrinier
- CIC-Nancy
Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy] - Institut National de la Santé et de la Recherche Médicale - CIC14334 rue du Morvan - Bâtiment Louis Mathieu - 54500 Vandoeuvre-les-Nancy Cedex
| | - Daniel Thomas
- Institut de Cardiologie [CHU Pitié-Salpêtrière]
Assistance publique - Hôpitaux de Paris (AP-HP) - CHU Pitié-Salpêtrière [APHP] - 52 boulvard Vincent Auriol, 75013 Paris France
| | - Bruno Hoen
- Centre d'Investigation Clinique Antilles Guyane, INSERM CIC 1424
Centre Hospitalo-Universitaire de Pointe-à-Pitre/Abymes -
- Service des Maladies Infectieuses et Tropicales[Point-à-Pitre]
CHU Pointe à Pitre - Guadeloupe
- EA 4537, Maladies Infectieuses et Tropicales dans la Caraïbe
Université des Antilles (Pôle Guadeloupe) -
| | - François Alla
- CIC-Nancy
Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy] - Institut National de la Santé et de la Recherche Médicale - CIC14334 rue du Morvan - Bâtiment Louis Mathieu - 54500 Vandoeuvre-les-Nancy Cedex
- UL, Université de Lorraine
34 cours Léopold - CS 25233 - 54052 Nancy Cedex
- APEMAC, Maladies Chroniques, Santé Perçue, et Processus d'Adaptation. Approches Epidémiologiques et Psychologiques.
Université Paris Descartes - Paris 5 - EA 4360Université de Lorraine - EA 4360Université de Lorraine, Faculté de Médecine, 9 avenue de la Forêt de Haye, 54505 Vandoeuvre Les Nancy
| |
Collapse
|
13
|
Njuguna B, Delahaye F. Infective endocarditis prophylaxis: a review. Expert Rev Cardiovasc Ther 2017; 15:127-136. [PMID: 28076699 DOI: 10.1080/14779072.2017.1281743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Guidelines for prophylaxis against infective endocarditis (IE) have changed significantly due to a lack of evidence for its efficacy and increasing concerns about safety and antibiotic resistance. The impact of these changes on clinical practice and IE hospitalisation trends and outcomes has become a focus of research. Areas covered: We review the rationale for and against IE prophylaxis, highlight significant changes in guidelines since 2002, and discuss literature examining the impact of these changes on antibiotic prescription rates for IE prophylaxis, IE incidence, morbidity, and mortality. We included English articles published since 2002 relevant to IE prophylaxis. Expert commentary: Existing guidelines recommend limited to no prophylaxis against IE but differ on which patient populations would benefit most. Antibiotic prescription rates for IE prophylaxis have declined as a result of newer restrictive guidelines, most significantly in the UK where IE prophylaxis is not recommended. However, conflicting data exists on the impact of these changes on the trends of IE hospitalisation and clinical outcomes. Definitive studies to resolve this controversy do not seem feasible in the near future but well designed prospective observational studies may provide novel information on the long term impact of the new guidelines.
Collapse
Affiliation(s)
- Benson Njuguna
- a Department of Pharmacy , Moi Teaching and Referral Hospital - Pharmacy , Eldoret , Kenya
| | - Francois Delahaye
- b Hospices civils de Lyon; Université Claude Bernard , University of Lyon - Cardiology , Lyon , France
| |
Collapse
|
14
|
de Souza AF, Rocha AL, Castro WH, Ferreira FM, Gelape CL, Travassos DV, da Silva TA. Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis? IJC HEART & VASCULATURE 2016; 12:57-62. [PMID: 28616544 PMCID: PMC5454162 DOI: 10.1016/j.ijcha.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/27/2016] [Accepted: 07/03/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is a serious disease that affects the surface of the endocardium. The spread of microorganisms from the oral cavity has been associated with the occurrence of IE. OBJECTIVE To analyze whether dental treatment before cardiac valve surgery (CVS) influenced the occurrence of IE. METHODS We performed a retrospective analysis of the medical and dental histories of patients undergoing CVS from 2004 to 2014. The sample consisted of 481 patients who underwent CVS divided into two groups: patients submitted to dental treatment prior to CVS (n = 110) and patients undergoing CVS without dental treatment (n = 371). RESULTS Of the total sample, 38 patients (8%) were diagnosed with IE. No significant difference was detected (p = 0.496) in comparing the occurrence of IE in the group with dental preparation (6.4%) and without dental preparation (8.4%). The logistic regression model confirmed that dental treatment did not change the IE risk (p = 0.504) and indicated that age (p < 0.003) and gender (p = 0.013) were significant risk factors for IE. There was a high demand for dental procedures in the group receiving dental preparation, with no significant differences between the patients with or without IE. Hemoculture indicated qualitative differences in comparing patients with and without dental treatment, especially in the frequency of Staphylococcus and Streptococcus. CONCLUSIONS The results did not allow for the determination of the impact of dental treatment before CVS on IE outcomes. However, it was not possible to exclude the potential beneficial effects of dental treatment in the prevention of IE.
Collapse
Affiliation(s)
- Alessandra Figueiredo de Souza
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Amanda Leal Rocha
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Wagner Henriques Castro
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Fernanda Morais Ferreira
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Claudio Léo Gelape
- Department of Surgery, Faculty of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Denise Vieira Travassos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Tarcília Aparecida da Silva
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| |
Collapse
|
15
|
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3073] [Impact Index Per Article: 341.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
Collapse
|
16
|
Abstract
Practical relevance: Periodontal disease is commonly encountered in feline practice. Gingivitis, followed by inflammation of the rest of the periodontal tissues, can lead to chronic oral infection, bacteraemia, pain and ultimately tooth loss. Given adequate plaque control and thorough, consistent dental home care, gingivitis is a reversible and controllable condition. Periodontitis, however, is an essentially irreversible and progressive condition. Treatment aims to control tissue inflammation, returning the gingiva to clinical health and preventing destruction of the periodontium in other parts of the mouth. Clinical challenges: Diagnosis must be established using a combination of oral examination under anaesthesia and dental radiography. Periodontitis leads to tooth attachment loss, and given the short length of most cat teeth, probing depths of 1 mm or more should alert the clinician to the presence of periodontitis. The decision of whether to extract or preserve affected teeth needs careful consideration. In practice, as periodontitis is often associated with type 1 tooth resorption, extraction is often required, but the slender and delicate nature of feline tooth roots, compounded by the destructive nature of tooth resorption, can frustrate extraction attempts. As highlighted in this article, iatrogenic damage to teeth is also a real risk if periodontal therapy procedures (including scaling and polishing) are not performed carefully. The challenges of providing home care in the cat are additionally discussed. Evidence base: The authors have drawn upon, wherever possible, an evidence base relating strictly to the feline patient. Where there is a lack of published research, evidence from canine and human studies is assessed.
Collapse
Affiliation(s)
- Rachel Perry
- Perrydental Vet Ltd, Grove Lodge Veterinary Hospital, Upper Brighton Road, Worthing, West Sussex, BN14 9DL, UK
| | - Cedric Tutt
- Cape Animal Dentistry Service, 78 Rosmead Avenue, Kenilworth, 7708, Cape Town, South Africa
| |
Collapse
|
17
|
Carr AB. Evidence and the Practice of Prosthodontics: 20 Years after EBD Introduction. J Prosthodont 2014; 24:12-6. [DOI: 10.1111/jopr.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Alan B. Carr
- Chair; Department of Dental Specialties; Mayo Clinic; Rochester; MN; Division Director; ACP Education & Research; Mentor to; ACP Cochrane Oral Health Group; Prosthodontic Practice Network
| |
Collapse
|