Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures

BACKGROUND Antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) is recommended to prevent infective endocarditis (IE) in those at high IE risk, but there are sparse data supporting a link between IDPs and IE or AP efficacy in IE prevention. OBJECTIVES The purpose of this study was to investigate any association between IDPs and IE, and the effectiveness of AP in reducing this. METHODS We performed a case-crossover analysis and cohort study of the association between IDPs and IE, and AP efficacy, in 7,951,972 U.S. subjects with employer-provided Commercial/Medicare-Supplemental coverage. RESULTS Time course studies showed that IE was most likely to occur within 4 weeks of an IDP. For those at high IE risk, case-crossover analysis demonstrated a significant temporal association between IE and IDPs in the preceding 4 weeks (OR: 2.00; 95% CI: 1.59-2.52; P = 0.002). This relationship was strongest for dental extractions (OR: 11.08; 95% CI: 7.34-16.74; P < 0.0001) and oral-surgical procedures (OR: 50.77; 95% CI: 20.79-123.98; P < 0.0001). AP was associ-ated with a significant reduction in IE incidence following IDP (OR: 0.49; 95% CI: 0.29-0.85; P = 0.01). The cohort study confirmed the associations between IE and extractions or oral surgical procedures in those at high IE risk and the effect of AP in reducing these associations (extractions: OR: 0.13; 95% CI: 0.03-0.34; P < 0.0001; oral surgical procedures: OR: 0.09; 95% CI: 0.01-0.35; P = 0.002). CONCLUSIONS We demonstrated a significant temporal association between IDPs (particularly extractions and oral -surgical procedures) and subsequent IE in high???IE-risk individuals, and a significant association between AP use and reduced IE incidence following these procedures. These data support the American Heart Association, and other, recommendations that those at high IE risk should receive AP before IDP. (J Am Coll Cardiol 2022;80:1029???1041) ?? 2022 by the American College of Cardiology Foundation.

Automated summary

This study found a significant temporal association between invasive dental procedures (IDPs), particularly extractions and oral-surgical procedures, and subsequent infective endocarditis (IE) in individuals at high-risk for IE. The use of antibiotic prophylaxis (AP) was associated with a significant reduction in IE incidence following these procedures.