Oral bacteria in infective endocarditis requiring surgery: a retrospective analysis of 134 patients

Abstract

Objectives It has been reported that bacteria associated with infective endocarditis originate from the oral cavity in 26–45% of cases. However, little is known on the counts and species of periodontal microbiota in infected heart valves. The aim of this study was to identify these aspects of periodontal microbiota in infective endocarditis and to potentially initiate a dental extraction concept for periodontally compromised teeth concerning patients requiring heart valve surgery. Materials and methods The retrospective study group consisted of tissue samples from infected heart valves of 683 patients who had undergone heart valve surgery. Before patients had undergone cardiac surgery, the following laboratory tests confirmed the occurrence of endocarditis in all patients: blood cultures, echocardiography, electrocardiography, chest X-ray, and electrophoresis of the serum proteins. The specimens were aseptically obtained and deep frozen immediately following surgery. Microbiological diagnosis included proof of germs (dichotomous), species of germs, and source of germs (oral versus other). Results Microbiota was detected in 134 (31.2%) out of 430 enrolled patients. Oral cavity was supposed to be the source in 10.4% of cases, whereas microbiota of the skin (57.5%) and gastrointestinal tract (GIT, 24.6%) were detected considerably more frequently. Moreover, periodontal bacteria belonged mostly to the Streptococci species and the yellow complex. None of the detected bacteria belonged to the red complex. Conclusion Most frequently, the skin and GIT represented the site of origin of the microbiota. Nevertheless, the oral cavity represented the source of IE in up to 10%. Consequently, it needs to be emphasized that a good level of oral hygiene is strongly recommended in all patients undergoing heart valve surgery in order to reduce the bacterial load in the oral cavity, thereby minimizing the hematogenous spread of oral microbiota. The prerequisites for conservative dental treatment versus radical tooth extraction must always be based on the patient’s cooperation, and the clinical intraoral status on a sense of proportion in view of the overall clinical situation due to the underlying cardiac disease. Clinical relevance The oral cavity is a source of oral microbiota on infected heart valves. Patients requiring heart valve surgery should always undergo a critical evaluation of dental treatment affecting periodontally compromised teeth, favoring a systematic, conservative-leaning recall.

Bibliometric research on analysis of links between periodontitis and cardiovascular diseases

“…These lesions can cause inflammation and damage to the heart tissues. According to Herbert Deppe's study, 10% of bacterial sources of infective endocarditis are from oral pathogens ( 52 ). Furthermore, Rinaldo et al also reported that infective endocarditis in patients with heart valve prostheses was mainly caused by oral bacteria in young male adults in Brazil and 77% of infective endocarditis cases were at high or moderate risk for periodontal disease ( 53 ).…”

‘A series of unfortunate events’: a case report of infective endocarditis resulting from ventricular arrhythmia ablation

“…Origin of microbiota in IE varies from bacteria of the skin, gastrointestinal tract, to oral cavity microbiota. 8 According to Murdoch et al ., the most common cause of IE is S. aureus , which can be found both in microbiota of the skin and oral cavity. 9 , 10 A common and often omitted source of inflammation and bacteraemia is an oral cavity, especially dental caries.…”

Regulatory effects of oral microbe on intestinal microbiota and the illness

“…Moreover, P. gingivalis and F. nucleatum can be parasitic on dendritic cells or macrophages and disrupt extraoral tissues ( Carrion et al, 2012 ; Xue et al, 2018 ). Oral microbes, including P. gingivalis , Actinomyces , Streptococcus , and Treponema denticola , have been confirmed as sources of non-oral organs in a colonizing manner ( Figuero et al, 2014 ; Zhang et al, 2021 ; Deppe et al, 2022 ). Chronic oral infection establishes F. nucleatum colonization that significantly induces systemic humoral IgG and IgM antibody responses ( Velsko et al, 2015 ).…”

“…It is widely acknowledged the linkage (not causation) between periodontal disease and atherosclerotic vascular disease. Oral microbes, including P. gingivalis , Actinomyces , Streptococcus , and Treponema denticola , have been confirmed as sources of infected heart valves, atherosclerotic plaques, and rheumatic heart valves ( Figuero et al., 2014 ; Zhang et al., 2021 ; Deppe et al., 2022 ). In this way, pathogens and their metabolites may be disseminated to the intestine similarly.…”