Thornhill, M. orcid.org/0000-0003-0681-4083, Gibson, T., Yoon, F. et al. (5 more authors) (2022) Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. Journal of the American College of Cardiology, 80 (11). pp. 1029-1041. ISSN 0735-1097
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022, American College of Cardiology Foundation. Published by Elsevier. This is an author produced version of a paper subsequently published in Journal of the American College of Cardiology. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Infective endocarditis; antibiotic prophylaxis; dental procedures; guidelines; prevention; risk |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Clinical Dentistry (Sheffield) |
Funding Information: | Funder Grant number DELTA DENTAL nan |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 27 Jun 2022 15:18 |
Last Modified: | 17 Aug 2023 00:13 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.jacc.2022.06.030 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:188008 |
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