Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures (2024)

• ¹Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts

  See Also

  Dental Clinics Amsterdam IJburglaan - Jouw tandarts in IJburgJ DENTAL CARE SRL EV37150: JDEvolution Plus

• ²Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

• ³Department of Oral Medicine, University of Pennsylvania, Philadelphia

• ⁴Unit of Oral and Maxillofacial Surgery, Ca’Foncello Hospital, Treviso, Italy

• ⁵Division of Oral Medicine, Department of Oral Biology and Diagnostic Sciences, Augusta University, Augusta, Georgia

• ⁶Department of Oral Medicine and Periodontology, Mahidol University, Bangkok, Thailand

• ⁷Department of Oral Medicine and Periodontology, University of the Western Cape, Cape Town, South Africa

• ⁸UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS-CESPU), Gandra, Portugal

• ⁹Dental Medicine Library, University of Pennsylvania, Philadelphia

• ¹⁰Faculty of Dentistry, National University of Singapore, Singapore

• ¹¹Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy

• ¹²Department of Otolaryngology, Wake Forest University School of Medicine, Atrium Health, Charlotte, North Carolina

• ¹³Department of Oral and Maxillofacial Medicine, Surgery and Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom

• ¹⁴Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain

• ¹⁵Branch of Medical Statistics, Biometry, and Epidemiology G.A. Maccacaro, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

• ¹⁶Fondazione IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Key Points

Question Is antibiotic prophylaxis associated with decreased risk of infective endocarditis after invasive dental procedures?

Findings This systematic review and meta-analysis including data on 1 152 345 cases of infective endocarditis found that antibiotic prophylaxis was associated with a reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk but not in those at moderate or low/unknown risk.

Meaning These findings support the use of antibiotic prophylaxis for individuals at high risk undergoing invasive dental procedures, supporting current American Heart Association and European Society of Cardiology guidelines.

Importance The association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007.

Objective To systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures.

Data Sources PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023.

Study Selection Studies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included.

Data Extraction and Synthesis Study quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis.

Main Outcomes and Measures The outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis.

Results Of 11 217 records identified, 30 were included (1 152 345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity = .51; I², 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci–infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis.

Conclusions and Relevance While results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.

Infectious Diseases Cardiology

Citation

Sperotto F, France K, Gobbo M, et al. Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis. JAMA Cardiol. 2024;9(7):599–610. doi:10.1001/jamacardio.2024.0873

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