Epprecht Jana, Ledergerber Bruno, Frank Michelle, Greutmann Matthias, van Hemelrijck Mathias, Ilcheva Lilly, Padrutt Maria, Stadlinger Bernd, Özcan Mutlu, Carrel Thierry, Hasse Barbara
Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
JACC Adv. 2024 Sep 6;3(10):101266. doi: 10.1016/j.jacadv.2024.101266. eCollection 2024 Oct.
The well-established connection between oral bacteria and infective endocarditis (IE) has prompted discussions about using antibiotic prophylaxis (AP) before invasive dental procedures. In 2007/2008, guidelines restricted AP from moderate and high-risk to exclusively high-risk patients.
The authors aimed to assess whether the proportion of oral streptococcal IE increased in moderate-risk patients using University Hospital Zurich data from 2000 to 2022.
Adult IE patients were categorized into risk groups based on European Society of Cardiology and Swiss guidelines. The investigation focused on analyzing the proportion of oral streptococcal IE across different risk groups in two distinct periods (1: 2000-2008; 2: 2009-2022). Logistic regression models, adjusted for various factors, were employed.
Of 752 IE cases, 163 occurred in period 1, and 589 in period 2. Oral streptococci caused 22% of cases. Proportions of streptococcal IE in period 1 versus period 2 were 24% versus 16% in high-risk, 24% versus 39% in moderate-risk, 33% versus 7% in low-/unknown-risk, and 18% versus 14% in no-risk patients. Compared to the other risk groups, the moderate-risk group had a 22% higher chance of oral streptococcal IE in period 2. After multivariable adjustment, moderate-risk patients had twice the risk of oral streptococcal IE compared to period 1 (OR: 2.59 [95% CI: 1.16-5.81]). Among moderate-risk conditions, congenital valve anomalies were associated with oral streptococcal IE (unadjusted OR: 2.52 [95% CI: 1.71-3.71]).
Oral streptococcal IEs increased in the moderate-risk group of patients after the AP guideline change. Exploring the potential necessity for expanding AP indications to certain patient groups with congenital valve anomalies may be warranted.
口腔细菌与感染性心内膜炎（IE）之间已确立的关联引发了关于在侵入性牙科手术前使用抗生素预防（AP）的讨论。2007/2008年，指南将AP的适用范围从中高风险患者限制为仅高风险患者。
作者旨在利用苏黎世大学医院2000年至2022年的数据，评估中度风险患者中口腔链球菌性IE的比例是否增加。
根据欧洲心脏病学会和瑞士指南，将成年IE患者分为不同风险组。调查重点分析了两个不同时期（1：2000 - 2008年；2：2009 - 2022年）不同风险组中口腔链球菌性IE的比例。采用了针对各种因素进行调整的逻辑回归模型。
在752例IE病例中，163例发生在第1期，589例发生在第2期。口腔链球菌导致了22%的病例。第1期与第2期相比，高风险组中链球菌性IE的比例分别为24%和16%，中度风险组为24%和39%，低/未知风险组为33%和7%，无风险患者为18%和14%。与其他风险组相比，中度风险组在第2期发生口腔链球菌性IE的可能性高22%。经过多变量调整后，中度风险患者发生口腔链球菌性IE的风险是第1期的两倍（比值比：2.59 [95%置信区间：1.16 - 5.81]）。在中度风险情况下，先天性瓣膜异常与口腔链球菌性IE相关（未调整比值比：2.52 [95%置信区间：1.71 - 3.71]）。
AP指南变更后，中度风险组患者的口腔链球菌性IE有所增加。探索将AP适应症扩大到某些患有先天性瓣膜异常的患者群体的潜在必要性可能是有必要的。
