1
|
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: 57] [Impact Index Per Article: 8.1] [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
|
2
|
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: 27] [Impact Index Per Article: 3.9] [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
|
3
|
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
|
4
|
Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol 2012; 59:1968-76. [PMID: 22624837 DOI: 10.1016/j.jacc.2012.02.029] [Citation(s) in RCA: 257] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/10/2012] [Accepted: 02/14/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate temporal trends in infective endocarditis (IE) incidence and clinical characteristics after 2002 French IE prophylaxis guideline modifications. BACKGROUND There are limited data on changes in the epidemiology of IE since recent guidelines recommended restricting the indications of antibiotic prophylaxis of IE. METHODS Three 1-year population-based surveys were conducted in 1991, 1999, and 2008 in 3 French regions totaling 11 million inhabitants age ≥20 years. We prospectively collected IE cases from all medical centers and analyzed age- and sex-standardized IE annual incidence trends. RESULTS Overall, 993 expert-validated IE cases were analyzed (323 in 1991; 331 in 1999; and 339 in 2008). IE incidence remained stable over time (95% confidence intervals given in parentheses/brackets): 35 (31 to 39), 33 (30 to 37), and 32 (28 to 35) cases per million in 1991, 1999, and 2008, respectively. Oral streptococci IE incidence did not increase either in the whole patient population (8.1 [6.4 to 10.1], 6.3 [4.8 to 8.1], and 6.3 [4.9 to 8.0] in 1991, 1999, and 2008, respectively) or in patients with pre-existing native valve disease. The increased incidence of Staphylococcus aureus IE (5.2 [3.9 to 6.8], 6.8 [5.3 to 8.6], and 8.2 [6.6 to 10.2]) was not significant in the whole patient population (p = 0.228) but was significant in the subgroup of patients without previously known native valve disease (1.6 [0.9 to 2.7], 3.7 [2.6 to 5.1], and 4.1 [3.0 to 5.6]; p = 0.012). CONCLUSIONS Scaling down antibiotic prophylaxis indications was not associated with an increased incidence of oral streptococcal IE. A focus on avoidance of S. aureus bacteremia in all patients, including those with no previously known valve disease, will be required to improve IE prevention.
Collapse
|