Incidence of infective endocarditis caused by viridans group streptococci in Sweden – effect of cessation of antibiotic prophylaxis in dentistry for risk individuals
Abstract:Introduction: In October 2012, the Swedish Medical Products Agency published new recommendations for the cessation of prophylactic antibiotics in dentistry for the prevention of infective endocarditis (IE). Previously, 2 g of amoxicillin per os would be administered 1 h before invasive dental procedures to patients with valve prosthesis, complicated heart valve disease, and to those with previous endocarditis. Objectives: The aim of this study was to evaluate whether the total incidence of IE caused by oral vi… Show more
“… 4 Fourteen studies included investigations included all patient age groups. Vähäsarja et al 10 included patients aged ≥17 years, Ahtela et al 11 and Jordal et al 12 included patients aged ≥18 years and Shah 13 included patients aged ≥20 years. IE predominantly affected men, as reported in all but one study.…”
Section: Resultsmentioning
confidence: 99%
“…The pooled regression estimate was 4.1%±1.2% per year increase in IE incidence, amounting to a compound increase in incidence of 106% over 18 years. The two Swedish studies 10 16 used different databases and differed in methodology; hence, they were excluded from the primary analysis. They were included in online supplemental table 2 and figure 1 , which demonstrated an overall estimated percent annual increase of 2.8%±1.0%.…”
AimTo provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe.MethodsA systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence.ResultsOf 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%.ConclusionBased on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase.Trial registeration numberCRD42020191196.
“… 4 Fourteen studies included investigations included all patient age groups. Vähäsarja et al 10 included patients aged ≥17 years, Ahtela et al 11 and Jordal et al 12 included patients aged ≥18 years and Shah 13 included patients aged ≥20 years. IE predominantly affected men, as reported in all but one study.…”
Section: Resultsmentioning
confidence: 99%
“…The pooled regression estimate was 4.1%±1.2% per year increase in IE incidence, amounting to a compound increase in incidence of 106% over 18 years. The two Swedish studies 10 16 used different databases and differed in methodology; hence, they were excluded from the primary analysis. They were included in online supplemental table 2 and figure 1 , which demonstrated an overall estimated percent annual increase of 2.8%±1.0%.…”
AimTo provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe.MethodsA systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence.ResultsOf 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%.ConclusionBased on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase.Trial registeration numberCRD42020191196.
“…IE prophylaxis has changed according to more recent recommendations, restricting the indication to only patients at the highest risk undergoing procedures likely to result in bacteremia with a microorganism that has the potential ability to cause IE [ 46 , 101 ] ( Table 8 ). Despite this more restrictive indication, no clear increase in the incidence of IE hospitalizations has been found after 2007 [ 102 , 103 , 104 ]. High-risk procedures, for which IE antibiotic prophylaxis would be recommended, include oral procedures with the manipulation of the gingival or periapical dental mucosa or perforation of the oral mucosa [ 46 , 101 ].…”
Infective endocarditis in children is a rare entity that poses multiple challenges. A history of congenital heart disease is the most common risk factor, although in recent years, other emerging predisposing conditions have gained relevance, such as central venous catheters carriers or children with chronic debilitating conditions; cases in previously healthy children with no medical history are also seen. Diagnosis is complex, although it has improved with the use of multimodal imaging techniques. Antibiotic treatment should be started early, according to causative microorganism and risk factors. Complications are frequent and continue to cause significant morbidity. Most studies have been conducted in adults and have been generalized to the pediatric population, with subsequent limitations. Our manuscript presents a comprehensive review of pediatric infective endocarditis, including recent advances in diagnosis and management.
“…Dementsprechend wird derzeit in Großbritannien betont, dass der Patient selbst eine fundierte Entscheidung, „informed decision/consent“ „Informed decision/consent“ , treffen sollte [ 46 ]. In Schweden wird seit Oktober 2012 empfohlen, die Antibiotikaprophylaxe sowohl für Patientengruppen mit geringem als auch mit hohem Risiko einzustellen [ 47 ], was zu einem Rückgang der Antibiotikaverschreibungen von mehr als 20 % führte [ 48 ]. Vähäsarja et al.…”
Section: Inzidenz Und Evidenzlageunclassified
“…untersuchten in einer epidemiologischen Registerstudie von 2020, ob dies zu einem Anstieg an infektiösen Endokarditiden führte. Die Autoren kamen zu dem Ergebnis, dass in der schwedischen Allgemeinbevölkerung nach 2012 im Vergleich zu den Vorjahren kein statistisch signifikanter Anstieg der Inzidenz einer infektiösen Endokarditis existierte [ 48 ]. Auch in Nordamerika führte die Restriktion der Antibiotikaprophylaxe auf Hochrisikopatienten zu keinem Anstieg der streptokokkenassoziierten infektiösen Endokarditis [ 49 ].…”
Für die Effektivität und Effizienz einer antibiotischen Prophylaxe vor zahnmedizinischen Eingriffen zum Schutz vor einer infektiösen Endokarditis liegt nur eine geringe Evidenz vor, die keine Rechtfertigung zur generalisierten Therapie von Patienten mit einem erhöhten Endokarditisrisiko darstellt. Aktuelle Leitlinien empfehlen daher, Antibiotika im Rahmen der Endokarditisprophylaxe auf Patienten zu beschränken, die zum einen ein hohes Risiko für die Entstehung einer infektiösen Endokarditis aufweisen und die sich zum anderen zahnärztlichen Eingriffen mit höchstem Endokarditisrisiko unterziehen. Einen hohen Stellwert besitzen allerdings auch Mund- und Hauthygienemaßnahmen, die nicht nur auf Risikopatienten, sondern auch auf die Allgemeinbevölkerung angewendet werden sollten, da die Inzidenz der infektiösen Endokarditis bei Patienten ohne anamnestisch bekannte Herzerkrankung zunehmend ansteigt.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
