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Li M, Kim JB, Sastry BKS, Chen M. Infective endocarditis. Lancet 2024; 404:377-392. [PMID: 39067905 DOI: 10.1016/s0140-6736(24)01098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
First described more than 350 years ago, infective endocarditis represents a global health concern characterised by infections affecting the native or prosthetic heart valves, the mural endocardium, a septal defect, or an indwelling cardiac device. Over recent decades, shifts in causation and epidemiology have been observed. Echocardiography remains pivotal in the diagnosis of infective endocarditis, with alternative imaging modalities gaining significance. Multidisciplinary management requiring expertise of cardiologists, cardiovascular surgeons, infectious disease specialists, microbiologists, radiologists and neurologists, is imperative. Current recommendations for clinical management often rely on observational studies, given the limited number of well conducted randomised controlled trials studying infective endocarditis due to the rarity of the disease. In this Seminar, we provide a comprehensive overview of optimal clinical practices in infective endocarditis, highlighting key aspects of pathophysiology, pathogens, diagnosis, management, prevention, and multidisciplinary approaches, providing updates on recent research findings and addressing remaining controversies in diagnostic accuracy, prevention strategies, and optimal treatment.
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Affiliation(s)
- Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Aortic Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - B K S Sastry
- Department of Cardiology, Renova Century Hospital, Hyderabad, Telangana, India
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Sarkisova F, Morse Z, Lee K, Bostanci N. Oral Irrigation Devices: A Scoping Review. Clin Exp Dent Res 2024; 10:e912. [PMID: 38881230 PMCID: PMC11180943 DOI: 10.1002/cre2.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps. METHODS The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting. RESULTS Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices. CONCLUSIONS Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.
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Affiliation(s)
- Farzana Sarkisova
- Department of Oral HealthAuckland University of TechnologyAucklandNew Zealand
| | - Zac Morse
- Department of Oral HealthAuckland University of TechnologyAucklandNew Zealand
| | - Kevin Lee
- Department of Food Science and MicrobiologyAuckland University of TechnologyAucklandNew Zealand
| | - Nagihan Bostanci
- Department of Dental Medicine, Division of Oral Health and PeriodontologyKarolinska InstitutetStockholmSweden
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Thornhill M, Prendergast B, Dayer M, Frisby A, Lockhart P, Baddour LM. New evidence calls into question NICE's endocarditis prevention guidance. Br Dent J 2024; 236:702-708. [PMID: 38730167 PMCID: PMC11087242 DOI: 10.1038/s41415-024-7344-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 05/12/2024]
Abstract
In 2008, National Institute for Health and Care Excellence (NICE) guidelines recommended against the use of antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent infective endocarditis (IE). They did so because of lack of AP efficacy evidence and adverse reaction concerns. Consequently, NICE concluded AP was not cost-effective and should not be recommended. In 2015, NICE reviewed its guidance and continued to recommend against AP. However, it subsequently changed its wording to 'antibiotic prophylaxis against infective endocarditis is not routinely recommended'. The lack of explanation of what constituted routinely (and not routinely), or how to manage non-routine patients, caused enormous confusion and NICE remained out of step with all major international guideline committees who continued to recommend AP for those at high risk.Since the 2015 guideline review, new data have confirmed an association between IDPs and subsequent IE and demonstrated AP efficacy in reducing IE risk following IDPs in high-risk patients. New evidence also shows that in high-risk patients, the IE risk following IDPs substantially exceeds any adverse reaction risk, and that AP is therefore highly cost-effective. Given the new evidence, a NICE guideline review would seem appropriate so that UK high-risk patients can receive the same protection afforded high-risk patients in the rest of the world.
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Affiliation(s)
- Martin Thornhill
- Professor of Translational Research in Dentistry, Unit of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Bernard Prendergast
- Professor of Cardiology, Guy´s and St Thomas´ Hospital, London and Chair of Cardiology, Cleveland Clinic, London, UK
| | - Mark Dayer
- Professor and Consultant Cardiologist, Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland
| | | | - Peter Lockhart
- Research Professor, Department of Oral Medicine/Oral and Maxillofacial Surgery, Atrium Health´s Carolinas Medical Centre, Charlotte, North Carolina, USA; Adjunct Professor, Department of Otolaryngology, Wake Forest University School of Medicine, North Carolina, USA
| | - Larry M Baddour
- Professor Emeritus, Division of Public Health, Infectious Diseases and Occupational Health, Departments of Medicine and Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Dayer MJ, Quintero-Martinez JA, Thornhill MH, Chambers JB, Pettersson GB, Baddour LM. Recent Insights Into Native Valve Infective Endocarditis: JACC Focus Seminar 4/4. J Am Coll Cardiol 2024; 83:1431-1443. [PMID: 38599719 DOI: 10.1016/j.jacc.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 04/12/2024]
Abstract
This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective endocarditis. In 2023, new diagnostic criteria were published by the Duke-International Society of Cardiovascular Infectious Diseases group. New pathogens were designated as typical, and findings on computed tomography imaging were included as diagnostic criteria. It is now recognized that a multidisciplinary approach to care is vital, and the role of an "endocarditis team" is highlighted. Recent studies have suggested that a transition from intravenous to oral antibiotics in selected patients may be reasonable, and the role of long-acting antibiotics is discussed. It is also now clear that an aggressive surgical approach can be life-saving in some patients. Finally, results of several recent studies have suggested there is an association between dental and other invasive procedures and an increased risk of developing infective endocarditis. Moreover, data indicate that antibiotic prophylaxis may be effective in some scenarios.
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Affiliation(s)
- Mark J Dayer
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland; Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
| | - Juan A Quintero-Martinez
- Department of Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Martin H Thornhill
- Department of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - John B Chambers
- Emeritus Professor of Clinical Cardiology at Guy's and St Thomas' NHS Trust, London, United Kingdom, and Kings College, London, United Kingdom
| | | | - Larry M Baddour
- Department of Medicine and Department of Cardiovascular Medicine, Division of Public Health, Infectious Diseases and Occupational Health, Mayo Clinic, Rochester, Minnesota, USA
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Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, O'Gara PT, Baddour LM. Endocarditis, invasive dental procedures, and antibiotic prophylaxis efficacy in US Medicaid patients. Oral Dis 2024; 30:1591-1605. [PMID: 37103475 DOI: 10.1111/odi.14585] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Antibiotic prophylaxis is recommended before invasive dental procedures to prevent endocarditis in those at high risk, but supporting data are sparse. We therefore investigated any association between invasive dental procedures and endocarditis, and any antibiotic prophylaxis effect on endocarditis incidence. SUBJECTS AND METHODS Cohort and case-crossover studies were performed on 1,678,190 Medicaid patients with linked medical, dental, and prescription data. RESULTS The cohort study identified increased endocarditis incidence within 30 days of invasive dental procedures in those at high risk, particularly after extractions (OR 14.17, 95% CI 5.40-52.11, p < 0.0001) or oral surgery (OR 29.98, 95% CI 9.62-119.34, p < 0.0001). Furthermore, antibiotic prophylaxis significantly reduced endocarditis incidence following invasive dental procedures (OR 0.20, 95% CI 0.06-0.53, p < 0.0001). Case-crossover analysis confirmed the association between invasive dental procedures and endocarditis in those at high risk, particularly following extractions (OR 3.74, 95% CI 2.65-5.27, p < 0.005) and oral surgery (OR 10.66, 95% CI 5.18-21.92, p < 0.0001). The number of invasive procedures, extractions, or surgical procedures needing antibiotic prophylaxis to prevent one endocarditis case was 244, 143 and 71, respectively. CONCLUSIONS Invasive dental procedures (particularly extractions and oral surgery) were significantly associated with endocarditis in high-risk individuals, but AP significantly reduced endocarditis incidence following these procedures, thereby supporting current guideline recommendations.
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Affiliation(s)
- Martin H Thornhill
- Unit of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
- Department Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - Frank Yoon
- IBM Watson Health, Ann Arbor, Michigan, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Peter B Lockhart
- Department Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Mitov G, Kilgenstein R, Partenheimer P, Ricart S, Ladage D. Infective endocarditis: prevention strategy and risk factors in an animal model. Folia Med (Plovdiv) 2023; 65:788-799. [PMID: 38351762 DOI: 10.3897/folmed.65.e99682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/22/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Infective endocarditis is a serious infection of the endocardium, especially the heart valves, which is associated with a high mortality rate. It generally occurs in patients with altered and abnormal cardiac architecture combined with exposure to bacteria from trauma and other potentially high-risk activities with transient bacteremia.
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Affiliation(s)
- Gergo Mitov
- Danube Private University, Krems an der Donau, Austria
| | | | | | - Serge Ricart
- Danube Private University, Krems an der Donau, Austria
| | - Dennis Ladage
- Danube Private University, Krems an der Donau, Austria
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Lockhart PB, Chu V, Zhao J, Gohs F, Thornhill MH, Pihlstrom B, Mougeot FB, Rose GA, Sun YP, Napenas J, Munz S, Farrehi PM, Sollecito T, Sankar V, O'Gara PT. Oral hygiene and infective endocarditis: a case control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:333-342. [PMID: 37085335 DOI: 10.1016/j.oooo.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To determine if oral hygiene is associated with infective endocarditis (IE) among those at moderate risk for IE. STUDY DESIGN This is a case control study of oral hygiene among hospitalized patients with IE (cases) and outpatients with heart valve disease but without IE (controls). The primary outcome was the mean dental calculus index. Secondary outcomes included other measures of oral hygiene and periodontal disease (e.g., dental plaque, gingivitis) and categorization of blood culture bacterial species in case participants. RESULTS The 62 case participants had 53% greater mean dental calculus index than the 119 control participants (0.84, 0.55, respectively; difference = 0.29, 95% CI: 0.11, 0.48; P = .002) and 26% greater mean dental plaque index (0.88, 0.70, respectively; difference = 0.18, 95% CI: 0.01.0.36; P = .043). Overall, cases reported fewer dentist and dental hygiene visits (P = .013) and fewer dental visits in the 12 weeks before enrollment than controls (P = .007). Common oral bacteria were identified from blood cultures in 27 of 62 cases (44%). CONCLUSIONS These data provide evidence to support and strengthen current American Heart Association guidance that those at risk for IE can reduce potential sources of IE-related bacteremia by maintaining optimal oral health through regular professional dental care and oral hygiene procedures.
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Affiliation(s)
- Peter B Lockhart
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA.
| | - Vivian Chu
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Jing Zhao
- Atrium Health Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Frank Gohs
- Atrium Health Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Martin H Thornhill
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA; Department of Oral and Maxillofacial Medicine, Oral Surgery and Oral Pathology, University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Bruce Pihlstrom
- Department of Developmental and Surgical Sciences, University of Minnesota, School of Dentistry, Minneapolis, MN, USA
| | - Farah Bahrani Mougeot
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, Microbiome Research Laboratory, Charlotte, NC, USA
| | | | - Yee-Ping Sun
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel Napenas
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA
| | - Stephanie Munz
- Department of Oral & Maxillofacial Surgery/Hospital Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Peter M Farrehi
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vidya Sankar
- Division of Oral Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Diagnostic Sciences, Tufts University School of Dentistry, Boston, MA, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
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Garrido L, Lyra P, Rodrigues J, Viana J, Mendes JJ, Barroso H. Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness. J Pers Med 2023; 13:1332. [PMID: 37763100 PMCID: PMC10532628 DOI: 10.3390/jpm13091332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
A good oral health status is mostly dependent on good oral hygiene habits, which knowingly impacts systemic health. Although controversial, chemical oral antiseptics can be useful in adjunct use to mechanical dental plaque control techniques in the prevention and management of local and overall health and well-being. This review aims to revisit, gather and update evidence-based clinical indications for the use of the most popular oral antiseptics, considering different types, microorganism targets and effectiveness in order to establish updated clinical recommendations.
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Affiliation(s)
| | | | | | | | | | - Helena Barroso
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal (P.L.); (J.V.); (J.J.M.)
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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.
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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.
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Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, O'Gara PT, Baddour LM. Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures. J Am Coll Cardiol 2022; 80:1029-1041. [PMID: 35987887 DOI: 10.1016/j.jacc.2022.06.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) is recommended to prevent infective endocarditis (IE) in those at high IE risk, but there are sparse data supporting a link between IDPs and IE or AP efficacy in IE prevention. OBJECTIVES The purpose of this study was to investigate any association between IDPs and IE, and the effectiveness of AP in reducing this. METHODS We performed a case-crossover analysis and cohort study of the association between IDPs and IE, and AP efficacy, in 7,951,972 U.S. subjects with employer-provided Commercial/Medicare-Supplemental coverage. RESULTS Time course studies showed that IE was most likely to occur within 4 weeks of an IDP. For those at high IE risk, case-crossover analysis demonstrated a significant temporal association between IE and IDPs in the preceding 4 weeks (OR: 2.00; 95% CI: 1.59-2.52; P = 0.002). This relationship was strongest for dental extractions (OR: 11.08; 95% CI: 7.34-16.74; P < 0.0001) and oral-surgical procedures (OR: 50.77; 95% CI: 20.79-123.98; P < 0.0001). AP was associated with a significant reduction in IE incidence following IDP (OR: 0.49; 95% CI: 0.29-0.85; P = 0.01). The cohort study confirmed the associations between IE and extractions or oral surgical procedures in those at high IE risk and the effect of AP in reducing these associations (extractions: OR: 0.13; 95% CI: 0.03-0.34; P < 0.0001; oral surgical procedures: OR: 0.09; 95% CI: 0.01-0.35; P = 0.002). CONCLUSIONS We demonstrated a significant temporal association between IDPs (particularly extractions and oral-surgical procedures) and subsequent IE in high-IE-risk individuals, and a significant association between AP use and reduced IE incidence following these procedures. These data support the American Heart Association, and other, recommendations that those at high IE risk should receive AP before IDP.
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Affiliation(s)
- Martin H Thornhill
- Unit of Oral and Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom; Department of Oral Medicine, Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA.
| | | | - Frank Yoon
- IBM Watson Health, Ann Arbor, Michigan, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, Somerset, United Kingdom
| | | | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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13
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Moby V, Millot S, Erpelding ML, Euvrard E, Bourgeois G, Martin-Thomé H, Chirouze C, Tattevin P, Strady C, Agrinier N, Alla F, Iung B, Selton-Suty C, Hoen B, Duval X. Poor oral health and hygiene habits in patients with infective endocarditis and previously identified predisposing cardiac condition: a prospective cohort study. J Infect 2022; 84:e58-e61. [PMID: 35247467 DOI: 10.1016/j.jinf.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Vanessa Moby
- CHRU Nancy, Service Odontologie, F-54000 Nancy, France; Faculté d'Odontologie, Université de Lorraine, F-54000 Nancy, France; Université de Lorraine, CNRS, IMoPA, F-54000 Nancy, France
| | - Sarah Millot
- Service de chirurgie orale, Centre hospitalier universitaire de Montpellier, 34295 Montpellier, France; INSERM, Centre de Recherches sur l'inflammation, Université de Paris, UMR 1149/ERL CNRS 8252, Paris 75018, France
| | - Marie-Line Erpelding
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000 Nancy, France
| | - Edouard Euvrard
- Service de Chirurgie Maxillo-Faciale, de Stomatologie et d'Odontologie (Head: Pr Christophe Meyer), Centre hospitalier Universitaire de Besançon, F-25000 Besançon, France; EA 4662, Laboratoire Nanomédecine, Imagerie et Thérapeutique (LNIT) (Head : Pr Frédéric Auber), Université de Franche-Comté, F-25000 Besançon, France
| | | | - Hélène Martin-Thomé
- Private practice, Maison des consultations de l'hôpital privé, Sévigné, France
| | - Catherine Chirouze
- UMR 6249 Chrono-Environnement, service de maladies infectieuses et tropicales, CNRS - Université de Franche-Comté, CHRU Besançon, France
| | - Pierre Tattevin
- Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, CHU Rennes, France
| | - Christophe Strady
- Cabinet d'infectiologie, Clinique Saint André-Groupe Courlancy, 51100 Reims, France
| | - Nelly Agrinier
- CHRU Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie clinique, F-54000, Nancy, France
| | - Francois Alla
- Centre de recherche Bordeaux Population Health, UMR 1219, CIC-EC 1401, Université de Bordeaux, Bordeaux, France; Service de Prévention, CHU, Bordeaux, France
| | - Bernard Iung
- Bichat Hospital APHP, Université de Paris, Paris, France
| | | | - Bruno Hoen
- Institut Pasteur, Centre de Recherche Translationnelle, 25-28 rue du Docteur Roux, 75724 Paris Cedex 15, France.
| | - Xavier Duval
- Inserm CIC 1425, Paris, France; AP-HP, University Hospital of Bichat, Paris, France; Inserm UMR-1137 IAME, Paris, France; University Paris Diderot, UFR de Médecine-Bichat, Paris 7, Paris, France
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14
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Harky A, Zaim S, Mallya A, George JJ. Optimizing outcomes in infective endocarditis: A comprehensive literature review. J Card Surg 2020; 35:1600-1608. [PMID: 32598562 DOI: 10.1111/jocs.14656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite being rare, infective endocarditis (IE) is a life-threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. AIMS In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. MATERIALS & METHODS A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included 'Endocarditis', 'IE', 'Infection', 'Vegetation', 'Duke criteria', 'native valve infection', 'prosthetic valve', 'valve infection', 'endocarditis outcome' and 'endocarditis bacteriology'. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. RESULTS All the relevant findings are summarized in specified tables and within appropriate sections. DISCUSSION It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at-risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. CONCLUSION Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Sevim Zaim
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Apeksha Mallya
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Joel Jacob George
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
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15
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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16
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Vandersluis YR, Suri S. Infective endocarditis and orthodontic implications in children: A review of the literature. Am J Orthod Dentofacial Orthop 2020; 157:19-28. [DOI: 10.1016/j.ajodo.2019.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/30/2022]
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17
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Cloitre A, Lesclous P, Trochu Q, Selton-Suty C, Boutoille D, Le Tourneau T, Delahaye F, Thomas D, Iung B, Gaudin A, Duval X, Trochu J. Antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions: French cardiologists' implementation of current guidelines. Int J Cardiol 2020; 299:222-227. [DOI: 10.1016/j.ijcard.2019.07.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/19/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
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18
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Hsieh FC, Huang CY, Lin SF, Sun JT, Yen TH, Chang CC. Short-term exposure to particulate matters is associated with septic emboli in infective endocarditis. Medicine (Baltimore) 2019; 98:e17899. [PMID: 31702666 PMCID: PMC6855621 DOI: 10.1097/md.0000000000017899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This survey was to investigate the short-term effect of particulate matters (PMs) exposure on clinical and microbiological variables, especially septic emboli, in infective endocarditis (IE). The study analyzed 138 IE patients in Far Eastern Memorial Hospital from 2005 to 2015 and clinical variables were retrospectively requested. The data of air quality were recorded and collected by a network of 26 monitoring stations spreading in Northern part of Taiwan. We found that IE patients with septic emboli were found to be exposed to a significantly higher level of PM2.5 (32.01 ± 15.89 vs. 21.70 ± 13.05 μg/m, P < .001) and PM10 (54.57 ± 24.43 vs 40.98 ± 24.81 μg/m, P = .002) on lag 0 day when compared to those without. Furthermore, multivariate regression analysis revealed that that ambient exposure to PM2.5 (odds ratio: 3.87, 95% confidence interval: 1.31-8.31; P = .001) and PM10 (odds ratio: 4.58, 95% confidence interval: 2.03-10.32; P < .001) significantly increased risk of septic emboli in IE patients. To our knowledge, this is the first study demonstrating that short-term exposure to PMs was associated with septic emboli in IE.
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Affiliation(s)
- Fu-Chien Hsieh
- Division of Cardiovascular Surgery, Cardiovascular Center
| | | | - Sheng-Feng Lin
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei
| | | | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University
- Kidney Research Center
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei
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19
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Calibrated interdental brushing for the prevention of periodontal pathogens infection in young adults - a randomized controlled clinical trial. Sci Rep 2019; 9:15127. [PMID: 31641199 PMCID: PMC6805917 DOI: 10.1038/s41598-019-51938-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022] Open
Abstract
Periodontal disease is clearly correlated with systemic disease. The presence of periodontal pathogens in interdental spaces in young, healthy adults is a strong indicator of the need to introduce daily interdental prophylaxis. Twenty-five subjects (aged 18–35 years), diagnosticated clinically as periodontally healthy, were enrolled in this study. One hundred interdental sites were included. Among these sites, 50 “test” sites were cleaned daily with calibrated interdental brushes (IDBs), whereas the other 50 sites were not cleaned and considered “controls”. The interdental biofilm at these interdental sites was collected at the beginning of the study (basal) and at 1 week, 2 weeks, 3 weeks, 4 weeks, and 3 months. Real-time polymerase chain reaction (PCR) methodology was used to quantify (i) 19 periodontal bacteria, including Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, and (ii) total bacteria. In the test sites, the quantity of total bacteria decreased over time with the use of IDBs. The bacteria from the red and orange Socransky complexes, which are associated with periodontal disease, significantly decreased in the test sites but not in the control sites. Bacteria from the yellow, and purple Socransky complexes, which are associated with periodontal health, increased significantly in both groups whereas bacteria from the blue Socransky complex increased significantly only in the test sites. Furthermore, at basal, 66% of test sites and 68% of control sites bled during interdental brushing. These percentages decreased by 85% in 3 months for the test sites and by 27% in the control sites. In conclusion, the daily use of calibrated IDBs can reduce periodontal pathogens, reestablish symbiotic microbiota and, decrease interdental inflammation in interdental sites of healthy young adults.
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20
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Infective endocarditis - An update for dental surgeons. ACTA ACUST UNITED AC 2019; 38:2-7. [PMID: 29229070 DOI: 10.1016/j.sdj.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023]
Abstract
Infective endocarditis (IE) is associated with significant morbidity and mortality. The prevention of infective endocarditis, for many years, has involved the identification of at risk patients undergoing medical or dental procedures and the use of pre-procedural antibiotic prophylaxis. However, evidence regarding the effectiveness of such measures is lacking while evidence is mounting for the adverse effects of inappropriate antibiotic use. International guidelines for antibiotic prophylaxis were amended, radically in some cases to reflect this. Subsequent epidemiological observations of IE have shown mixed results, strengthening calls for well conducted randomised control trials, now that there is genuine clinical equipoise among clinicians about this question.
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21
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Duval X, Millot S, Tubiana S, Iung B. Prévention de l’endocardite infectieuse. Presse Med 2019; 48:556-562. [DOI: 10.1016/j.lpm.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/04/2019] [Indexed: 12/29/2022] Open
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Dental treatment and recommended management in patients at risk of infective endocarditis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:37-41. [PMID: 31043974 PMCID: PMC6491369 DOI: 10.5114/kitp.2019.83944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022]
Abstract
Infective endocarditis (IF) is found in high-risk groups with congenital or acquired cardiac defects. It is caused by episodes of short bacteraemia. The magnitude and duration of bacteraemia caused by dental procedures are decreased by using antibiotic prophylaxis (AP). The aim of this study is to describe and discuss all clinical implications related to IF and dental procedures, and AP before invasive dental procedures. Maintenance of optimal oral health and hygiene is more important than AP in decreasing the risk of IF. Routine daily activities are associated with a similar risk of bacteraemia. It is estimated that antibiotics use in dentistry may represent up to 10% of total antibiotics use, and the risk of developing bacterial resistance should be taken into account.
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23
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Ercibengoa M, Goenaga MA, Ardanuy C, Grau I, García-de-la-Maria C, Almela M, Miro JM, Navas E, Fariñas MC, de Alegría CR, de la Torre J, Fernández F, Marín M, Muñoz P, Orden B, Oteo JA, García-Álvarez L, de Alarcón A, Jiménez JAL, Marimón JM. Epidemiological and clinical characteristics of Streptococcus tigurinus endocarditis. BMC Infect Dis 2019; 19:291. [PMID: 30922322 PMCID: PMC6440093 DOI: 10.1186/s12879-019-3914-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Streptococcus tigurinus was recently described as a new streptococcal species within the viridans group streptococci (VGS). The objectives of the present work were to analyse the clinical and microbiological characteristics of S. tigurinus isolated from patients with bacteraemias, to determine the prevalence of S. tigurinus among VGS endocarditis in Spain, and to compare the clinical characteristics and outcomes of endocarditis caused by S. tigurinus and other VGS. Methods Retrospective nationwide study, performed between 2008 and 2016 in 9 Spanish hospitals from 7 different provinces comprising 237 cases of infective endocarditis. Streptococcal isolates were identified by sequencing fragments of their 16S rRNA, sodA and groEL genes. Clinical data of patients with streptococcal endocarditis were prospectively collected according to a pre-established protocol. Results Patients with endocarditis represented 7/9 (77.8%) and 26/86 (30.2%) of the bacteraemias caused by S. tigurinus and other VGS, respectively (p < 0.001), in two of the hospital participants. Among patients with streptococcal endocarditis, 12 different Streptococcus species were recognized being S. oralis, S. tigurinus and S. mitis the three more common. No relevant statistical differences were observed in the clinical characteristics and outcomes of endocarditis caused by the different VGS species. Conclusions In this multicenter study performed in Spain, S. tigurinus showed a higher predilection for the endocardial endothelium as compared to other VGS. However, clinical characteristics and outcomes of endocarditis caused by S. tigurinus did not significantly differ from endocarditis caused by other oral streptococci.
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Affiliation(s)
| | | | - Carmen Ardanuy
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Servicio de Microbiologia, Hospital Universitari de Bellvitge. Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Immaculada Grau
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge. Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Cristina García-de-la-Maria
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manuel Almela
- Servicio de Microbiología, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose María Miro
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Enrique Navas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Carmen Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Carlos Ruiz de Alegría
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Javier de la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Fernando Fernández
- Servicio de Microbiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Mercedes Marín
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Departamento de Medicina, Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Departamento de Medicina, Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain
| | - Beatriz Orden
- Departamento de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Antonio Oteo
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, La Rioja, Spain
| | - Lara García-Álvarez
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, La Rioja, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine. Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Sevilla, Spain
| | - José Antonio Lepe Jiménez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine. Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Sevilla, Spain
| | - Jose María Marimón
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain. .,Servicio de Microbiología, Hospital Universitario Donostia-IIS Biodonostia, Paseo Dr Beguiristain s/n, 20014, San Sebastián, Spain.
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24
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Abstract
IMPORTANCE Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the length of treatment in the setting of emerging, sometimes inconclusive clinical research findings. OBSERVATIONS Community-associated infective endocarditis remains the predominant form of the disease; however, health care accounts for one-third of cases in high-income countries. As medical interventions are increasingly performed on older patients, the disease incidence from cardiac implanted electronic devices is also increasing. In addition, younger patients involved with intravenous drug use has increased in the past decade and with it the proportion of US hospitalization has increased to more than 10%. These epidemiological factors have led to Staphylococcus aureus being the most common cause in high-income countries, accounting for up to 40% of cases. The mainstays of diagnosis are still echocardiography and blood cultures. Adjunctive imaging such as cardiac computed tomographic and nuclear imaging can improve the sensitivity for diagnosis when echocardiography is not conclusive. Serological studies, histopathology, and polymerase chain reaction assays have distinct roles in the diagnosis of infective endocarditis when blood culture have tested negative with the highest yield obtained from serological studies. Increasing antibiotic resistance, particularly to S aureus, has led to a need for different antibiotic treatment options such as newer antibiotics and combination therapy regimens. Surgery can confer a survival benefit to patients with major complications; however, the decision to pursue surgery must balance the risks and benefits of operations in these frequently high-risk patients. CONCLUSIONS AND RELEVANCE The epidemiology and management of infective endocarditis are continually changing. Guidelines provide specific recommendations about management; however, careful attention to individual patient characteristics, pathogen, and risk of sequela must be considered when making therapeutic decisions.
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Affiliation(s)
- Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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25
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Faraji R, Behjati-Ardakani M, Faraji N, Moshtaghioun SM, Kalantar SM, Pedarzadeh A, Zandi H, Sarebanhassanabadi M, Ahmadi N, Dehghani Firoozabadi A. Molecular Diagnosis of Bacterial Definite Infective Endocarditis by Real-Time Polymerase Chain Reaction. Cardiol Res 2018; 9:99-106. [PMID: 29755627 PMCID: PMC5942239 DOI: 10.14740/cr687w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/15/2018] [Indexed: 11/11/2022] Open
Abstract
Infective endocarditis (IE) can be diagnosed using the Duke criteria, which cannot be conclusive especially when the results of blood cultures are negative. This study aimed at using real-time polymerase chain reaction (PCR) technique to isolate bacteria present in whole blood samples of patients with definitive IE on the basis of the method designed in this study. This laboratory and test study was conducted on 20 whole blood samples taken from patients with definitive IE. Real-time PCR of the 16s rRNA was utilized to directly analyze whole blood samples to diagnose bacterial IE. Of 20 whole blood samples with definitive IE, only one blood culture (5%) was positive and the isolated bacterium belonged to Streptococci viridans group. Also, 13 whole blood samples were positive using real-time PCR technique. The isolated bacteria were Enterococcus faecalis with seven (35%) cases, Streptococcus gallolyticus with two (10%) cases, Streptococcus mutans with one (5%) case, Streptococcus sanguinis with one (5%) case, Streptococcus salivarius with one (5%) case, and Staphylococcus aureus with one (5%) case. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using real-time PCR technique were 65%, 100%, 100%, and 74%, respectively. The developed real-time PCR method allows us to detect bacteria in whole blood samples and is much more sensitive than culturing method. It also permits the differentiation of the main group of bacteria within a few hours for IE.
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Affiliation(s)
- Reza Faraji
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences,Yazd, Iran
| | | | - Nooshin Faraji
- Kermanshah Health Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Seyed Mehdi Kalantar
- Medical Genetic Research and Clinical Centre for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Pedarzadeh
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences,Yazd, Iran
| | - Hengameh Zandi
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Nastaran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences,Yazd, Iran
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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. Reply to Raoult. Clin Infect Dis 2018; 66:982-983. [DOI: 10.1093/cid/cix928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xavier Duval
- INSERM CIC-1425, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat
- INSERM UMR-1137 IAME, and Université Paris Diderot, UFR de Médecine-Bichat
| | - Sarah Millot
- UMR 1149-INSERM, CRI, Université Paris Diderot, Faculté de Médecine Bichât
| | - Catherine Chirouze
- UMR 6249 Laboratoire Chrono-environnement Université de Bourgogne Franche-Comté, Service de Maladies Infectieuses CHRU Besançon
| | | | - Vanessa Moby
- Service Odontologie, Centre Hospitalier Régional Universitaire, Nancy
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire, Rennes
| | - Christophe Strady
- Cabinet d’infectiologie, Clinique Saint André-Groupe Courlancy, Reims
| | - Edouard Euvrard
- INSERM, CIC-1431, and Service de Stomatologie, Chirurgie Maxillofaciale et Odontologie Hospitalière, CHRU Besançon
| | - Nelly Agrinier
- INSERM, CIC-1433 Epidémiologie Clinique, Centre Hospitalier Régional Universitaire, Nancy
| | - Daniel Thomas
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Cardiologie, Paris
| | - Bruno Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud
- Centre Hospitalier Universitaire de Pointe-à-Pitre, INSERM CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre
| | - François Alla
- Université de Lorraine, Université Paris Descartes, Apemac
- INSERM, CIC-1433, Nancy, France
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Raoult D. Endocarditis Prophylaxis. Clin Infect Dis 2018; 66:982. [DOI: 10.1093/cid/cix925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Didier Raoult
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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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.
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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
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