Maeda Keigo, Hirai Yuzo, Nashi Masanori, Yamamoto Shinsuke, Taniike Naoki, Takenobu Toshihiko
Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan.
J Dent Sci. 2022 Apr;17(2):870-875. doi: 10.1016/j.jds.2021.09.023. Epub 2021 Sep 28.
BACKGROUND/PURPOSE: The epidemiology of infective endocarditis (IE) is under constant change due to the aging society and increases in antimicrobial-resistant pathogens. However, IE remains severe. This study aimed to review the current clinical characteristics of IE and the antimicrobial susceptibility of oral bacteria (OB) isolated from blood cultures to implement appropriate antimicrobial prophylaxis.
We retrospectively investigated the clinical features of 180 patients with IE in whom OB and pathogens except OB (eOB) were identified as causative microorganisms via blood cultures. The susceptibility of the OB group to eight antibiotics was examined by broth microdilution.
Among causative microorganisms, the isolation rate of staphylococci was slightly higher than that of OB; however, the difference was not significant (36.7% vs. 33.8%, = 0.3203). The number of patients with underlying cardiac disease was significantly higher in the OB group than in the eOB group (53.7% vs. 34.1%, = 0.0113). Only one ampicillin-resistant OB was detected (2.0%). OBs were significantly less susceptible to clarithromycin and azithromycin than to ampicillin (98.0% vs. 66.7% and 98.0% vs. 60.0%, = 0.0003 and = 0.0003, respectively). Moreover, OBs were significantly less susceptible to clarithromycin and azithromycin than to clindamycin (66.7% vs. 88.2% and 60.0% vs. 88.2%, = 0.0301 and = 0.0217, respectively).
OBs were susceptible to ampicillin. However, the susceptibility of OBs to clarithromycin and azithromycin was significantly lower than that to ampicillin and clindamycin. These results are important and should help decisions regarding guide antimicrobial prophylaxis.
背景/目的：由于社会老龄化和耐抗菌性病原体的增加，感染性心内膜炎（IE）的流行病学在不断变化。然而，IE仍然很严重。本研究旨在回顾IE的当前临床特征以及从血培养中分离出的口腔细菌（OB）的抗菌药敏情况，以实施适当的抗菌预防措施。
我们回顾性调查了180例IE患者的临床特征，这些患者通过血培养确定OB和非OB病原体（eOB）为致病微生物。通过肉汤微量稀释法检测OB组对8种抗生素的敏感性。
在致病微生物中，葡萄球菌的分离率略高于OB，但差异不显著（36.7%对33.8%，P = 0.3203）。OB组潜在心脏病患者的数量显著高于eOB组（53.7%对34.1%，P = 0.0113）。仅检测到1株耐氨苄西林的OB（2.0%）。OB对克拉霉素和阿奇霉素的敏感性显著低于对氨苄西林的敏感性（分别为98.0%对66.7%和98.0%对60.0%，P = 0.0003和P = 0.0003）。此外，OB对克拉霉素和阿奇霉素的敏感性显著低于对克林霉素的敏感性（分别为66.7%对88.2%和60.0%对88.2%，P = 0.0301和P = 0.0217）。
OB对氨苄西林敏感。然而，OB对克拉霉素和阿奇霉素的敏感性显著低于对氨苄西林和克林霉素的敏感性。这些结果很重要，应有助于指导抗菌预防决策。
