Cambridge University Hospitals.
LKSS Deanery.
Br J Oral Maxillofac Surg. 2021 Apr;59(3):329-334. doi: 10.1016/j.bjoms.2020.08.095. Epub 2020 Aug 24.
Understanding the frequency of bacteraemia of dental origin that is implicated in severe infective endocarditis (IE) will further our understanding of the disease's pathoaetiology and help us take steps to reduce its prevalence. A total of 78 patients from the Royal Papworth Hospital, Cambridge, who had valve surgery due to IE (as confirmed by the Modified Duke Criteria) were included. Case notes were retrospectively reviewed for microorganisms that were implicated in the bacteraemia and IE. Associated factors were also recorded to determine whether they were different if a dental or non-dental pathogen was inoculated. A dental pathogen was implicated in 24 of the patients with IE; 20 had non-dental pathogens, and 30 were culture negative. This was not deemed statistically significant (p=0.54). Of the associated factors, only smoking was statistically significant with a greater proportion of non-smokers having bacteraemia of dental origin (p=0.03). No other associated factor was appreciably different based on the aetiology of the microorganism. Our results indicate that dental pathogens are not more likely to cause severe IE. We therefore advocate the stance adopted by the current national guidance on the judicious prescription of antibiotic prophylaxis for IE with regard to dental procedures.
了解与严重感染性心内膜炎（IE）相关的牙源菌血症的频率将有助于我们进一步了解该疾病的发病机制，并帮助我们采取措施降低其流行率。共有 78 名来自剑桥皇家帕普沃思医院的患者因 IE（经改良的杜克标准证实）接受了瓣膜手术。回顾性分析了与菌血症和 IE 相关的微生物。还记录了相关因素，以确定如果接种了牙源性或非牙源性病原体，这些因素是否不同。IE 患者中有 24 人被认为与牙源性病原体有关；20 人有非牙源性病原体，30 人培养结果为阴性。这在统计学上没有显著差异（p=0.54）。在相关因素中，只有吸烟在统计学上有显著差异，不吸烟者菌血症的牙源比例更高（p=0.03）。根据微生物的病因，没有其他相关因素明显不同。我们的结果表明，牙源性病原体不太可能导致严重的 IE。因此，我们支持当前国家指南对 IE 患者牙科手术预防性应用抗生素的合理处方所采取的立场。
