Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: Nationwide population based cohort and a case crossover study

January 6, 2018 at 12:11 pm

BMJ September 7, 2017 V.358 

Sarah Tubiana, epidemiologist12, Pierre-Olivier Blotière, statistician2, Bruno Hoen, professor3, Philippe Lesclous, professor4, Sarah Millot, associate professor5, Jérémie Rudant, epidemiologist2 , Alain Weill, epidemiologist2, Joel Coste, professor2, François Alla, professor2, Xavier Duval, professor1

1INSERM, 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

2Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France

3Service 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

4INSERM, U 1229, RMeS, Nantes, France, UFR d’Odontologie, Université de Nantes, Nantes, France, CHU Hôtel Dieu, Nantes, France

5Department of Odontology, CHRU Université de Montpellier, France; UMR 1149 INSERM, CRI. Université Paris Diderot, France

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.

FULL TEXT

http://www.bmj.com/content/358/bmj.j3776

PDF

http://www.bmj.com/content/bmj/358/bmj.j3776.full.pdf

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, Infecciones cardio-vasculares, Infecciones relacionadas a prótesis, Metodos diagnosticos, REPORTS, Sepsis, Update.

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