Antibiotic Prophylaxis For Infective Endocarditis Research Articles

Antibiotic-Prescribing Habits in Dentistry: A Questionnaire-Based Study.

A ten-question survey was administered to a group of Italian dentists. The participants were asked about their preferences for antibiotic administration for the prevention of infective endocarditis, the administration of antibiotics to patients allergic to penicillin, the insertion of implants, and the extraction of third molars. The retrieved data were screened and analyzed. A total of 298 surveys were filled out. The most-prescribed antibiotic was amoxicillin or amoxicillin with clavulanic acid or macrolides for allergic patients. The administration of two grams of amoxicillin one hour before surgery was the most widely used prescriptive protocol for prophylaxis. International guidelines on antibiotic prophylaxis for infective endocarditis were only partially followed. The most heterogeneous results emerged for prophylaxis associated with dental implants or provided prior to surgical third-molar extraction. The present study shows widespread antibiotic prescriptive heterogeneity among the sample of dentists analyzed, especially in conditions where international guidelines are lacking. An evidence-based consensus on prescriptive modalities in dentistry would be desirable in the near future.

Unveiling the Knowledge Gap Regarding Standard Antibiotic Prophylaxis for Infective Endocarditis Among Physicians, Dentists and Cardiologists in Pakistan: A Cross-Sectional Study.

Infective endocarditis is a microbial infection of the endocardial surface of the native and prosthetic valves. This study aimed to evaluate knowledge regarding the current guidelines for antibiotic prophylaxis for infective endocarditis. This cross-sectional study was conducted among physicians, cardiologists, and dentists in Rawalpindi and Islamabad. The questionnaire was distributed as Google Forms among the required population, and responses were collected on a Google Response Sheet. The participants viewed rheumatic heart disease (83.7%) and heart transplant (96.7%) as the most vulnerable conditions that warrant the need for antibiotic prophylaxis. The other questions yielded average responses. The findings of this study emphasize the importance of adhering to standard guidelines and highlight the need for knowledge of the current guidelines.

Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines.

The question of antibiotic prophylaxis and its role in prevention of infective endocarditis (IE) remains controversial, with differing recommendations from international societies. The aim of this review was to compare and contrast current recommendations on antibiotic prophylaxis for IE by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) and highlight the evidence supporting these recommendations. International guidelines for administration of antibiotic prophylaxis for prevention of IE are largely unchanged since 2009. Studies on the impact of the more restrictive antibiotic prophylaxis recommendations are conflicting, with several studies suggesting lack of adherence to current guidance from the ESC (2015), NICE (2016), and AHA (2021). The question of antibiotic prophylaxis in patients with IE remains controversial, with differing recommendations from international societies. Despite the change in guidelines more than 15years ago, lack of adherence to current guidelines persists. Due to the lack of high-quality evidence and the conflicting results from observational studies along with the lack of randomized clinical trials, the question of whether to recommend antibiotic prophylaxis or not in certain patient populations remains unanswered and remains largely based on expert consensus opinion.

Antibiotic prophylaxis for infective endocarditis during high-risk gastrointestinal procedures

Antibiotic prophylaxis for infective endocarditis during high-risk gastrointestinal procedures

Evaluation of Change in Knowledge, Attitude and Adoption Regarding Antibiotic Prophylaxis for Infective Endocarditis Before and After Health Education among Dental Interns in a Private Dental Teaching Institution in India

Background: There was paucity of data regarding updating of 2007 AHA (American Heart Association) guidelines among dentists in India.
 Objective: To evaluate change in knowledge, attitude and adoption of AHA (2007) guidelines regarding Antibiotic prophylaxis for Infective endocarditis before and after health education among dental interns in a private dental teaching institution.
 Materials and Methods: This was an interventional study conducted among dental interns in a teaching dental institution. Data was obtained using a validated questionnaire that finally had 32 items. Data was obtained by sharing an online link to complete survey. A reminder was also given one week later and participant responses obtained. Each correct response for a question was assigned a score of 1 while incorrect response was scored as zero. Total score was computed for each participant. Health education on AHA 2007 guidelines for antibiotic prophylaxis against infective endocarditis was offered to participants using power point presentation for about 30 -45 minutes on a scheduled day following baseline data collection. Immediately after health education, participants were again requested to fill the same questionnaire used at baseline. Mean knowledge score before and after health education was compared using paired sample t-test.
 Results: 74 participants were considered with response rate of 91.4%. Mean knowledge score significantly increased from 11.5 ± 4.3 (Mean ± Standard deviation) at baseline to 22.9 ± 4.2 post intervention (p < 0.001).
 Conclusion: Health education intervention was successful in improving knowledge, attitude and adoption of AHA 2007 guidelines for antibiotic prophylaxis against IE among dental interns.

Practical aspects of infective endocarditis prevention

The review is devoted to the practical aspects of infective endocarditis (IE) prevention, the issues of which, as before, remain the subject of lengthy discussions. Despite repeatedly updated national and international guidelines on this topic, medical practitioners are not always fully aware of antibiotic prophylaxis of IE. After a brief consideration of the etiological, pathogenetic features and risk factors of the disease, the main provisions of 2015 European Society of Cardiology guidelines on IE prevention, which were approved by the Russian Society of Cardiology, are presented. The categories of patients with the highest risk of IE, procedures associated with an increased risk of IE (dental and other invasive procedures) are described in detail. The main practical approaches to the identification of risk groups and performing invasive procedures that influence the decision to prescribe antibiotic prophylaxis are described. Particular attention is paid to the characteristics of both first-line antibiotic drugs and alternative agents for penicillin allergy or in cases of β-lactamase secreting pathogens.

Understanding valvular heart disease in the dental setting.

Limited evidence is available regarding dentists' knowledge and interpretation of infective endocarditis (IE) prophylaxis guidelines. The aim of this study was to determine understanding and management of rheumatic and non-rheumatic valvular heart disease (VHD) in the dental setting in Western Australia (WA). A cross-sectional survey of dentists within Perth utilized an online Qualtrics questionnaire developed after consultation with stakeholders. A sampling frame was compiled from the Australian Health Practitioner Regulation Agency with contact details obtained from the White Pages (online), using five quintiles of Socio-Economic Indexes for Areas according to dentist's place of practice. Of 41 (13.7% of 300 approached) dentists completing the survey (95.1% general dentists, mean years of practice=15.6), 90.2% reported following the Australian Therapeutic Guidelines (ATG) regarding IE antibiotic prophylaxis in VHD. Most (92.7%) were unaware of the rheumatic heart disease (RHD) control program. Nearly all participants indicated prophylaxis for clearly invasive procedures such as tooth extraction (100.0%) and periodontal surgery (95.1%). Many dentists made the decision to prescribe antibiotics themselves (36.6%). The majority of dentists followed the ATG's IE prophylaxis recommendations for cardiac lesions and dental procedures. There was limited knowledge of the national RHD guidelines and the WA RHD control program.

Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis- National survey study.

BackgroundThe objective of this study was to assess the attitude, practice, and knowledge of Croatian dentists regarding infective endocarditis (IE) prophylaxis. Material and MethodsA cross-sectional, self-reporting questionnaire survey was conducted with the participation of 348 Croatian dentists. The questionnaire was designed to collect information on participants’ work experience, place of work, their attitudes related to the treatment of IE-risk patients, knowledge and adherence to IE antibiotic prophylaxis guidelines. ResultsKnowledge and adherence to the current guidelines decreased with the higher years of experience. Compliance with the current guidelines varied, mostly because of respondents’ insecurity regarding which guidelines to follow. AHA guidelines have been most frequently the first choice (25% participants). Surprisingly, 23% of dentists didn’t follow any of the official guidelines. The majority of participants (68%) have declared a lack of preparedness or willingness to treat the patients at risk of IE. Dentists with specialty or working at university/hospital have shown a higher level of knowledge and preparedness to treat IE-risk patients. ConclusionsThe lack of knowledge of guidelines and consequent inconsistencies in IE antibiotic prophylaxis in Croatian dental practice indicates the need for urgent improvement. Key words:Antibiotic prophylaxis, dentistry, infective endocarditis.

Analysis of the frequency of bacteraemia of dental origin implicated in infective endocarditis in patients requiring valve surgery

Understanding the frequency of bacteraemia of dental origin that is implicated in severe infective endocarditis (IE) will further our understanding of the disease’s pathoaetiology and help us take steps to reduce its prevalence. A total of 78 patients from the Royal Papworth Hospital, Cambridge, who had valve surgery due to IE (as confirmed by the Modified Duke Criteria) were included. Case notes were retrospectively reviewed for microorganisms that were implicated in the bacteraemia and IE. Associated factors were also recorded to determine whether they were different if a dental or non-dental pathogen was inoculated. A dental pathogen was implicated in 24 of the patients with IE; 20 had non-dental pathogens, and 30 were culture negative. This was not deemed statistically significant (p=0.54). Of the associated factors, only smoking was statistically significant with a greater proportion of non-smokers having bacteraemia of dental origin (p=0.03). No other associated factor was appreciably different based on the aetiology of the microorganism. Our results indicate that dental pathogens are not more likely to cause severe IE. We therefore advocate the stance adopted by the current national guidance on the judicious prescription of antibiotic prophylaxis for IE with regard to dental procedures.

Prevention of infective endocarditis during dental extractions among Polish dentists - a contemporary nationwide survey.

Infective endocarditis (IE) is a potentially life-threatening condition. According to current ESC (European Society of Cardiology) guidelines, the use of antibiotic prophylaxis should only be reserved for specific dental procedures with interruption of consistency of the oral mucosa such as extractions and should be reserved for patients with the highest risk of developing IE. The aim of this study was to assess the knowledge of need for IE prophylaxis in de ned clinical settings among Polish dentists. A specially self-designed internet questionnaire was created concerning the topic of infective endocarditis prophylaxis in specific clinical scenarios for patients undergoing dental extractions during outpatient visits. The survey was made available to the dentists via internet and was active in March 2018. there were 352 Polish dentists who completed the survey. Antibiotic prophylaxis for IE during dental extractions was used in 93% of cases with prior IE, 89% with artificial heart valve, 69% with biological valve, 28% with pacemaker, 54% with coronary stent, 73% with cyanotic heart defect, 58% with diabetes mellitus, 20% after prior myocardial infarction and 54% with heart valve disease. There was a significant relationship between the time of working as a physician (>15 years) and more outdated or improper IE prophylaxis (p = 0.04). the management of patients for infective endocarditis prophylaxis undergoing dental extractions is suboptimal. Antibiotic therapy is overused in some clinical scenarios and on the other hand underutilized in those recommended by the current ESC guidelines.

Antibiotic prophylaxis of infective endocarditis in oral and maxillofacial surgery: incomplete implementation of guidelines in everyday clinical practice

Infective endocarditis (IE) is a devastating disease with high mortality. Most guidelines recommend routine use of antibiotic prophylaxis during oral surgery to prevent IE in patients with specific predisposing cardiac conditions, but this is not the case in the UK. The conflicting opinions and guidance are confusing and may affect IE prophylaxis implementation. We investigated how IE prophylaxis standards are defined in hospitals and outpatient clinics of oral and maxillofacial surgery. A survey was sent to 80 surgeons heading departments of oral and maxillofacial surgery in Germany. We observed significant heterogeneity in IE prophylaxis implementation among the clinics. This diversity was in relation to the definition of predisposing cardiac conditions, the type of dental and surgical procedures performed that require IE prophylaxis, the spectrum of compounds used, and the timing of antibiotic prophylaxis. We observed under-prescription of IE prophylaxis in high-risk patients, the overuse of antibiotic prophylaxis in patients not at high risk of IE, and the use of inappropriate drugs. These findings suggest that educational strategies and guideline implementation advice are needed to improve standards of IE prophylaxis in oral and maxillofacial surgery clinics.

АНТИБИОТИКОПРОФИЛАКТИКА ИНФЕКЦИОННОГО ЭНДОКАРДИТА НА СТОМАТОЛОГИЧЕСКОМ ПРИЕМЕ

Background. Infective endocarditis is a serious disease and has the risk of disability and high mortality. This disease can be a terrible complication of both general surgical and dental invasive procedures. The problem of infective endocarditis is relevant in most countries of the world, which determine the need for targeted prevention of dental interventions. The most important pathogenetic component of this disease is transient bacteremia, which develops when the skin and mucous membrane of the oral cavity are damaged under the influence of various traumatic agents. Antibiotic prophylaxis prevents of infective endocarditis and helps to reduce the risk. Objectives ― to identify and analyze the most effective methods of antibiotic prophylaxis of IE at the dental admission. Methodology. A review of literature - publications of domestic and foreign studies using the scientific search library databases PubMed, Medline, Cochrane, Elibrary. Total found 38 publications from Russia, USA, Germany, Jordan, Saudi Arabia, Singapore, Japan and other countries. Results. The review examines studies - questioning people, clinical studies with "double glare", publication of patents, revealing the attitude to antibiotic prophylaxis of infective endocarditis at a dental reception in the world, and also analyzed the choice of drugs and their use. Conclusions. The most preferred option is to carry out antibiotic prophylaxis of the disease in people with a high risk factor, which include patients with prosthetic heart valves, congenital heart defects and patients with a history of infectious endocarditis. The drug of choice among antibacterial agents is the use of amoxicillin / clavulanic acid combination.

Antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions: French cardiologists' implementation of current guidelines

BackgroundTo prevent infective endocarditis (IE), with the exception of the United Kingdom, antibiotic prophylaxis (AP) is recommended in patients with predisposing cardiac conditions (PCCs) worldwide. To conclude on the relevance of this strategy, how the current guidelines are applied is a crucial point to investigate. The first aim of this study was to assess cardiologists' implementation of the current guidelines. The secondary objective was to identify specific areas where the training and knowledge of French cardiologists could be improved. MethodsA national online survey was carried out among the 2228 cardiologist members of the French Society of Cardiology. ResultsThe high risk PCCs for which IE AP is recommended were correctly identified by the vast majority of the respondents so that IE AP is mostly prescribed correctly in such patients. But only 12% identified all the right indications for IE AP according to 13 predefined PCCs (3 at high-risk, 6 at moderate-risk and 4 at low-risk of IE) so that some IE AP misuses are recorded, overprescription in particular. Only 47% prescribed the proper amoxicillin schedule and only 15% prescribed the appropriate clindamycin schedule in cases with penicillin allergy. ConclusionThis study evidenced relevant areas where the training of cardiologists could be improved such as knowledge of the risk of IE for certain PCCs and some common invasive dental procedures. Cardiologists' knowledge should be improved before any conclusion can be drawn on the relevance of this AP strategy and its influence on IE incidence.

Antibiotic prophylaxis for the prevention of infective endocarditis for dental procedures is not associated with fatal adverse drug reactions in France.

BackgroundOne of the major reasons to stop antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) in the United Kingdom but not in the rest of the world was that it would result in more deaths from fatal adverse drug reactions (ADRs) than the number of IE deaths. The main aim of this study was to quantify and describe the ADRs with amoxicillin or clindamycin for IE AP. The second aim was to infer a crude incidence of anaphylaxis associated with amoxicillin for IE AP.Material and MethodsThe Medical Dictionary for Regulatory Activities (MedDRA) was used to group ADRs for IE AP using the broad Standardized MedDRA Queries “Anaphylactic reaction, Amoxicillin, Clindamycin, Clostridium Difficile infection” to the French Pharmacovigilance Database System. From this first-line collection, we selected all cases occurring for IE AP and ultimately, the cases for IE AP for a dental procedure. Then, each case was analyzed.ResultsOf 11639 first-line recorded ADRs, 100 were for IE AP but no fatal anaphylaxis to amoxicillin or clindamycin and no C. difficile infection associated with clindamycin were identified. Only 17 cases of anaphylaxis to amoxicillin related to dental procedures were highlighted. The estimation of the crude incidence rate of anaphylaxis associated with amoxicillin for IE AP for invasive dental procedure was 1/57 000 (95% CI 0.2-0.6).ConclusionsFatal or severe ADRs with amoxicillin or clindamycin is not a rational argument to stop IE AP before invasive dental procedures. Key words:Infective endocarditis, antibiotic prophylaxis, anaphylaxis, adverse drug reaction, amoxicillin, clindamycin, pharmacovigilance.

Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse

BackgroundThere is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. ObjectivesThis study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. MethodsThis analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). ResultsBAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. ConclusionsIE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.

Antibiotic prophylaxis of infective endocarditis in dental procedures: challenges, certainties, and perspectives

Antibiotic prophylaxis against infective endocarditis (IE) before dental procedures is currently limited to high-risk patients, yet there is no evidence of its efficacy/inefficacy in humans, and it is unlikely there will be for organizational and economic reasons. Most cases of endocarditis from oral streptococci are due to bacteremias associated with chewing and oral hygiene habits, which could be reduced by regular oral hygiene. Data from studies conducted after the most recent guidelines are not sufficient to establish a relationship between the reduction in patient groups to which antibiotic prophylaxis is given and the incidence trend of endocarditis from oral streptococci. This is mainly attributed to study limitations and lack of data on physicians' adherence to official recommendations. Patients at risk of IE should be made aware of the lack of firm evidence of the benefits of antibiotic prophylaxis for IE in humans and be involved in the decision to receive it or not. According to some studies, the administration of aspirin and ticlopidine to experimental animals followed by the induction of low-grade bacteremia has prevented IE in most cases. However, the possible use of these drugs in humans requires further clinical studies.

A nationwide survey of French dentists' knowledge and implementation of current guidelines for antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions

To prevent infective endocarditis in patients with predisposing cardiac conditions, antibiotic prophylaxis is recommended worldwide, except in the United Kingdom. To determine the relevance of this strategy, investigating how the current guidelines are applied is crucial. The first aim of this study was to assess dentists' implementation of the current guidelines. The secondary aims were to identify relevant areas to improve the training of dentists and to determine temporal trends in practitioners' attitudes by comparison with 2 previous surveys conducted in 1991 and 2001. An electronic national survey was sent to the 12,000 member practitioners of the French Union for Oral Health. Even though 58.9% of the respondents stated that their knowledge of current guidelines was good, a scoring system showed that only 34.5% had overall knowledge of these guidelines. This study revealed relevant areas to improve the training of dentists, such as knowledge of some cardiac conditions, the potential side effects of the antibiotics used, and the pathogenesis of infective endocarditis. Consequently, dentists' knowledge should be improved before any conclusions can be drawn on the relevance of this antibiotic prophylaxis strategy and its influence on infective endocarditis incidence.

Knowledge and practice of antibiotic prophylaxis for infective endocarditis among dental students

Background: Infective endocarditis (IE) is a microbial infection of the valves and endocardium of the heart. IE is difficult to treat and has a poor prognosis. Dentists play a major role in preventing IE in susceptible patients. In this study, we evaluate knowledge and practice of antibiotic prophylaxis for IE among dental students, interns and PGs at S. N. Dental College, Kalaburagi.Methods: A cross-sectional study was done by survey using questionnaire. Questionnaire was distributed to 159 dental students, interns and PGs at S. N. Dental College, Kalaburagi. Questionnaire included questions regarding to demographic information and knowledge and practice of the participants about antibiotic prophylaxis for IE.Results: Out of 159 participants 135 provided the response, giving a response rate of 85%. Overall, average of 52.7% of the participants had a good level of knowledge regarding the cardiac conditions that require antibiotic prophylaxis. Participants also had better knowledge regarding dental procedures that require prophylaxis with an average of 75.7%. But only 37.2% prescribed correct drug, dosage and regime of antibiotic prophylaxis.Conclusions: The level of knowledge and practice about antibiotics prophylaxis of IE amongst dental students, interns and PGs at the study site was not at an acceptable level. Awareness is essential because of the cardiac risks associated with the lack of appropriate prophylaxis. Up-to-date and accurate knowledge is mandatory for all dental students, interns and PGs who see and treat patients on a daily basis. This study emphasized the need for continuous education and for formal inclusion of the guidelines in the student’s curriculum.

Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves

ObjectivePatients with structural abnormalities of cardiac valves, including bicuspid aortic valve (BAV), are said to be at higher risk of infective endocarditis (IE). We sought to determine the risk of...

Antibiotic prophylaxis for infective endocarditis: some rarely addressed issues.

Although quite consistent indications on antibiotic prophylaxis for infective endocarditis (IE) have been reported internationally, several common dental practice issues are still not clear: which dental procedures require antibiotic prophylaxis? In the case of multiple procedures can the same antibiotic be used? How can dentists identify high-risk conditions for IE? Do dentists verify patient antibiotic intake? What are the requirements of antibiotic prophylaxis in cases of coexistence of diseases which involve host defence impairment? What are the modalities of second choice drug administration? And finally, are chlorhexidine mouthwashes before dental procedures combined with antibiotics useful or not? Uncertainty also persists as far as the real need for prophylaxis is concerned and although several sources have suggested that a wide prospective randomised controlled study may be the definitive solution, problems exist in performing such a study.