Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis.

Autor:	Sperotto F; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., France K; Department of Oral Medicine, University of Pennsylvania, Philadelphia., Gobbo M; Unit of Oral and Maxillofacial Surgery, Ca'Foncello Hospital, Treviso, Italy., Bindakhil M; Division of Oral Medicine, Department of Oral Biology and Diagnostic Sciences, Augusta University, Augusta, Georgia., Pimolbutr K; Department of Oral Medicine and Periodontology, Mahidol University, Bangkok, Thailand., Holmes H; Department of Oral Medicine and Periodontology, University of the Western Cape, Cape Town, South Africa., Monteiro L; UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS-CESPU), Gandra, Portugal., Graham L; Dental Medicine Library, University of Pennsylvania, Philadelphia., Hong CHL; Faculty of Dentistry, National University of Singapore, Singapore., Sollecito TP; Department of Oral Medicine, University of Pennsylvania, Philadelphia., Lodi G; Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy., Lockhart PB; Department of Otolaryngology, Wake Forest University School of Medicine, Atrium Health, Charlotte, North Carolina., Thornhill M; Department of Oral and Maxillofacial Medicine, Surgery and Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom., Diz Dios P; Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain., Turati F; Branch of Medical Statistics, Biometry, and Epidemiology G.A. Maccacaro, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy., Edefonti V; Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Jazyk:	angličtina
Zdroj:	JAMA cardiology [JAMA Cardiol] 2024 Jul 01; Vol. 9 (7), pp. 599-610.
DOI:	10.1001/jamacardio.2024.0873
Abstrakt:	Importance: The association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007. Objective: To systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures. Data Sources: PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023. Study Selection: Studies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included. Data Extraction and Synthesis: Study quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis. Main Outcomes and Measures: The outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis. Results: Of 11 217 records identified, 30 were included (1 152 345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity = .51; I2, 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci-infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis. Conclusions and Relevance: While results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.
Databáze:	MEDLINE
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