Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Infection. 2023 Feb;51(1):47-59. doi: 10.1007/s15010-022-01900-0. Epub 2022 Aug 16.
Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE.
We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol.
The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered.
Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.
感染性心内膜炎（IE）是一种严重的细菌感染。作为预防措施，过去曾建议在进行牙科手术前使用抗生素预防（AP）。然而，在 2007 年至 2009 年期间，IE 预防指南在全球范围内发生了变化，限制或支持完全停止 AP。AP 是否对 IE 有效仍不清楚。
我们进行了一项系统评价，即在任何牙科手术前，成人使用 AP 与不使用此类药物相比，对 IE 发病风险是否有影响。我们在 Cochrane 对照试验中心注册库（CENTRAL）、OVID 中的 MEDLINE 和 EMBASE 中搜索研究。两名不同的作者独立筛选文章，并根据预先制定的方案进行数据提取。
唯一符合我们标准的队列研究纳入了 IE 高危患者。对提取数据的分析表明，高危患者在接受侵入性牙科手术前使用 AP 可降低 IE 的风险，但无统计学意义（RR 0.39，p 值 0.11）。我们未发现其他纳入低危或中危 IE 患者的研究。对排除文章的定性评估表明结果存在多样性，并表明大多数最新的文章均存在效力不足的问题。
支持或反对在牙科手术前使用 AP 作为 IE 预防措施的证据非常有限。需要新的高质量研究，尽管此类研究需要较大的研究范围，并且可能无法立即实施。
