Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study.
BACKGROUND
Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear.


OBJECTIVE
To quantitate the risk for endocarditis from dental treatment and cardiac abnormalities.


METHODS
Population-based, case-control study.


METHODS
54 hospitals in the Philadelphia area.


METHODS
Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence.


METHODS
Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records.


RESULTS
During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 [95% CI, 0.4 to 1.5]). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 [CI, 7.4 to 37.4]). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 [CI, 6.4 to 58.4]), congenital heart disease (adjusted odds ratio, 6.7 [CI, 2.3 to 19.4]), cardiac valvular surgery (adjusted odds ratio, 74.6 [CI, 12.5 to 447]), rheumatic fever (adjusted odds ratio, 13.4 [CI, 4.5 to 39.5]), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 [CI, 2.0 to 8.9]). Among case-patients with known cardiac lesions--the target of prophylaxis--dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 [CI, 0.04 to 0.7] over 3 months). Few participants received prophylactic antibiotics.


CONCLUSIONS
Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered.
Strom
B L
BL
University of Pennsylvania School of Medicine, Veterans Affairs Medical Center, Philadelphia 19104-6021, USA. bstrom@cceb.med.upenn.edu
Abrutyn
E
E
Berlin
J A
JA
Kinman
J L
JL
Feldman
R S
RS
Stolley
P D
PD
Levison
M E
ME
Korzeniowski
O M
OM
Kaye
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000209:etiology* / Q000517:prevention & control; D003729:Dental Care / Q000009:adverse effects*; D004697:Endocarditis, Bacterial / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D013223:Statistics as Topic
D000900:Anti-Bacterial Agents