1
|
Celestin B, Habensus EI, Tubiana S, Préau M, Millot S, Lescure FX, Kerneis C, Para M, Duval X, Iung B. Determinants of adherence to oral hygiene prophylaxis guidelines in patients with previous infective endocarditis. Arch Cardiovasc Dis 2023; 116:176-182. [PMID: 36797077 DOI: 10.1016/j.acvd.2023.01.003] [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] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is characterized by low incidence but high mortality. Patients with a history of IE are at highest risk. Adherence to prophylaxis recommendations is poor. We sought to identify determinants of adherence to oral hygiene guidelines on IE prophylaxis in patients with a history of IE. METHODS Using data from the cross-sectional, single-centre POST-IMAGE study, we analysed demographic, medical and psychosocial factors. We defined patients as adherent to prophylaxis if they declared going to the dentist at least annually and brushing their teeth at least twice a day. Depression, cognitive status and quality of life were assessed using validated scales. RESULTS Of 100 patients enrolled, 98 completed the self-questionnaires. Among these, 40 (40.8%) were categorized as adherent to prophylaxis guidelines, and were less likely to be smokers (5.1% vs. 25.0%; P=0.02) or have symptoms of depression (36.6% vs. 70.8%; P<0.01) or cognitive decline (0% vs. 15.5%; P=0.05). Conversely, they had higher rates of: valvular surgery since the index IE episode (17.5% vs. 3.4%; P=0.04), searching for information on IE (61.1% vs. 46.3%, P=0.05), and considering themselves as adherent to IE prophylaxis (58.3% vs. 32.1%; P=0.03). Tooth brushing, dental visits and antibiotic prophylaxis were correctly identified as measures to prevent IE recurrence in 87.7%, 90.8% and 92.8% of patients, respectively, and did not differ according to adherence to oral hygiene guidelines. CONCLUSIONS Self-reported adherence to secondary oral hygiene guidelines on IE prophylaxis is low. Adherence is unrelated to most patient characteristics, but to depression and cognitive impairment. Poor adherence appears related more to a lack of implementation rather than insufficient knowledge. Assessment of depression may be considered in patients with IE.
Collapse
Affiliation(s)
- Bettia Celestin
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; Université Paris-Cité, 75018 Paris, France
| | - Emila Ilic Habensus
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Sarah Tubiana
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France
| | - Marie Préau
- Social Research Group (GRePS UR4163), Lumière Lyon 2 University, 69007 Lyon, France
| | - Sarah Millot
- Département de Médecine et Chirurgie Orale, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - François-Xavier Lescure
- Université Paris-Cité, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France; Infectious Disease Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Caroline Kerneis
- Cardiac Surgery Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Marylou Para
- Université Paris-Cité, 75018 Paris, France; Cardiac Surgery Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Xavier Duval
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France
| | - Bernard Iung
- Université Paris-Cité, 75018 Paris, France; Cardiology Department, Bichat Hospital, AP-HP, 75018 Paris, France.
| | | |
Collapse
|
3
|
Veloso TR, Oechslin F, Que YA, Moreillon P, Entenza JM, Mancini S. Aspirin plus ticlopidine prevented experimental endocarditis due to Enterococcus faecalis and Streptococcus gallolyticus. Pathog Dis 2015; 73:ftv060. [PMID: 26310867 DOI: 10.1093/femspd/ftv060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 01/01/2023] Open
Abstract
Enterococcus faecalis and Streptococcus gallolyticus cause infective endocarditis (IE), which can originate from the continuous release or translocation of low bacterial numbers into the bloodstream. In this context, IE cannot be prevented with antibiotics. We previously demonstrated that aspirin plus ticlopidine protected rats from IE due to S. gordonii and Staphylococcus aureus. Here we showed that aspirin plus ticlopidine significantly reduced vegetation weight and protected 73 and 64% rats (P < 0.005) from IE due to E. faecalis and S. gallolyticus, respectively. These results further support the potential use of aspirin plus ticlopidine for a global prevention of IE in high-risk patients.
Collapse
Affiliation(s)
- Tiago Rafael Veloso
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Frank Oechslin
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Lausanne University Hospital Center (CHUV), CH-1011 Lausanne, Switzerland
| | - Philippe Moreillon
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - José Manuel Entenza
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Stefano Mancini
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| |
Collapse
|
4
|
Infective endocarditis epidemiology and consequences of prophylaxis guidelines modifications: the dialectical evolution. Curr Infect Dis Rep 2014; 16:440. [PMID: 25233804 DOI: 10.1007/s11908-014-0440-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Historically, infective endocarditis (IE) affected patients with predisposing cardiac conditions and community-acquired bacteremia. Over the past 30 years, significant changes have occurred, regarding microorganisms, underlying valvular heart diseases, portals of entry, and patients' comorbidities. Given these epidemiological changes and unproven prophylaxis efficacy, experts in most countries currently limit antibiotic indications to patients with high-risk cardiac conditions having oral procedures and, in the UK, recommend discontinuing their use altogether. To date, no epidemiological impact on streptococcal IE incidence has been observed. Policy must now address these epidemiological modifications, focus on community-acquired and health care-associated staphylococcal bacteremia prevention, and prompt the adoption of broader and nonexclusively antibiotic-based strategies.
Collapse
|