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Goodlet KJ, McCreary EK, Nailor MD, Barnes D, Brokhof MM, Bova S, Clemens E, Kelly B, Lichvar A, Pluckrose DM, Summers BB, Szempruch KR, Tchen S. Therapeutic Myths in Solid Organ Transplantation Infectious Diseases. Open Forum Infect Dis 2024; 11:ofae342. [PMID: 38983710 PMCID: PMC11232700 DOI: 10.1093/ofid/ofae342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Infection management in solid organ transplantation poses unique challenges, with a diverse array of potential pathogens and associated antimicrobial therapies. With limited high-quality randomized clinical trials to direct optimal care, therapeutic "myths" may propagate and contribute to suboptimal or excessive antimicrobial use. We discuss 6 therapeutic myths with particular relevance to solid organ transplantation and provide recommendations for infectious diseases clinicians involved in the care of this high-risk population.
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Affiliation(s)
- Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University, Glendale, Arizona, USA
| | - Erin K McCreary
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael D Nailor
- Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Darina Barnes
- Department of Pharmacy, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Marissa M Brokhof
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Bova
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Evan Clemens
- Department of Pharmacy, University of Washington Medical Center, Seattle, Washington, USA
| | - Beth Kelly
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Alicia Lichvar
- Center for Transplantation, UC San Diego Health, San Diego, California, USA
| | - Dawn M Pluckrose
- Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bryant B Summers
- Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen R Szempruch
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Stephanie Tchen
- Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin, USA
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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.
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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
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Staedt H, Heimes D, Kämmerer PW. Antibiotika im Rahmen der Endokarditisprophylaxe – Risiko und Nutzen. WISSEN KOMPAKT : FORTBILDUNG FUR ZAHNARZTE 2021; 15:113-122. [PMID: 34426751 PMCID: PMC8374404 DOI: 10.1007/s11838-021-00134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Für die Effektivität und Effizienz einer antibiotischen Prophylaxe vor zahnmedizinischen Eingriffen zum Schutz vor einer infektiösen Endokarditis liegt nur eine geringe Evidenz vor, die keine Rechtfertigung zur generalisierten Therapie von Patienten mit einem erhöhten Endokarditisrisiko darstellt. Aktuelle Leitlinien empfehlen daher, Antibiotika im Rahmen der Endokarditisprophylaxe auf Patienten zu beschränken, die zum einen ein hohes Risiko für die Entstehung einer infektiösen Endokarditis aufweisen und die sich zum anderen zahnärztlichen Eingriffen mit höchstem Endokarditisrisiko unterziehen. Einen hohen Stellwert besitzen allerdings auch Mund- und Hauthygienemaßnahmen, die nicht nur auf Risikopatienten, sondern auch auf die Allgemeinbevölkerung angewendet werden sollten, da die Inzidenz der infektiösen Endokarditis bei Patienten ohne anamnestisch bekannte Herzerkrankung zunehmend ansteigt.
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Affiliation(s)
- H. Staedt
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
| | - D. Heimes
- Universitätsmedizin Mainz, Mainz, Deutschland
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie – plastische Operationen, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Augustusplatz 2, 55131 Mainz, Deutschland
| | - P. W. Kämmerer
- Universitätsmedizin Mainz, Mainz, Deutschland
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie – plastische Operationen, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Augustusplatz 2, 55131 Mainz, Deutschland
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