[Prevention of infective endocarditis: are recommendations about oral health procedures for high or moderate risk patients respected?].
BACKGROUND
Infective endocarditis (IE) is a rare but particularly serious disease. It frequently requires surgical treatment with cardiac valve replacement. In-hospital mortality is very high. The guidelines of the Society of Infectious Pathology of French Language (SPILF) for the prevention of infective endocarditis of at-risk patients were updated in 2002. They recommended a bi-annual oral health follow-up and antibiotic prophylaxis for invasive sequences of care for high-risk patients. The objective of the study was to assess the application of the guidelines.


METHODS
Using databases and medical files of self-employed persons insured by compulsory national health insurance in the Alps, we studied from January 2001 to December 2002 the oral ambulatory follow-up of patients with permanent health insurance for valvular heart disease or congenital heart disease.


RESULTS
Among the 260 patients with valvular heart disease or congenital heart disease, 125 (48.1%) presented medical claims for at least one dental treatment. Antibiotic prophylaxis was found in 15.8% of the invasive sequences of care for high-risk patients. The prescribed antibiotic was amoxicillin in 90% of the cases.


CONCLUSIONS
Guidelines are seldom applied. Public and practitioner awareness should be improved to promote oral health: patients should regularly consult their dentist, and practitioners should follow the guidelines for the prevention of infective endocarditis.
Guillaud
M
M
Caisse Maladie Régionale des Alpes, 2, avenue de l'Obiou, 38706 La Tronche. martine.guillaud@cmr-alpes.canam.fr
Blatier
J F
JF
Quillon
A
A
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009909:Oral Health / Q000592:standards*; D012307:Risk Factors
D000900:Anti-Bacterial Agents