title: Bacteremia after Endodontic Procedures in Patients with Heart Disease: Culture and Molecular Analyses.
abstract: BACKGROUND
  Infective endocarditis (IE) is still associated with high mortality, and antibiotic prophylaxis strategies are under intense debate. We evaluated the incidence of bacteremia after root canal preparation in teeth with necrotic pulps and apical periodontitis.
  
  
  METHODS
  Blood samples were taken before and 5 and 30 minutes after endodontic treatment in teeth with apical periodontitis from individuals at high (n = 21) or no risk (n = 11) for IE. The former received prophylactic antibiotic therapy. Bacteriologic samples were taken from root canals before chemomechanical preparation to confirm pulp infection. Samples were subjected to aerobic and anaerobic culture and quantitative real-time polymerase chain reaction (qPCR), the latter to determine the total bacterial and streptococcal levels.
  
  
  RESULTS
  Culture revealed no bacteremia in all individuals. Analysis by qPCR showed that bacterial DNA occurred in all root canal samples. qPCR showed a similar incidence of bacteremia between patients who received or did not receive prophylactic antibiotic therapy (P > .05). In blood samples taken 5 minutes after endodontic procedures, bacteria were detected in 2 of 11 (18%) individuals not taking antibiotics and in 4 of 21 (19%) patients under prophylaxis. After 30 minutes, the incidence of bacteremia decreased to 2 of 21 (10%) in patients taking antibiotics and was undetectable in patients at no risk of IE. The incidence of bacteremia by streptococci was identical as that for total bacteria.
  
  
  CONCLUSIONS
  No detectable bacteremia was evident by culture after treatment of infected root canals. Molecular analysis revealed bacterial DNA and streptococci in blood from some patients without a significant difference between individuals receiving or not receiving antibiotic prophylaxis.
authors.affiliation: National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Luciana C
authors.initials: LC
authors.lastname: Reis
authors.affiliation: Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Isabela N
authors.initials: IN
authors.lastname: Rôças
authors.affiliation: Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: José F
authors.initials: JF
authors.lastname: Siqueira
authors.affiliation: Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Milton
authors.initials: M
authors.lastname: de Uzeda
authors.affiliation: National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Vane S
authors.initials: VS
authors.lastname: Lacerda
authors.affiliation: Anaerobe Biology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Regina M C P
authors.initials: RM
authors.lastname: Domingues
authors.affiliation: Anaerobe Biology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Saulo R
authors.initials: SR
authors.lastname: Moraes
authors.affiliation: Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: roberto.saraiva@ini.fiocruz.br.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Saraiva
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D003786:Dental Pulp Cavity / Q000382:microbiology; D003790:Dental Pulp Necrosis / Q000382:microbiology; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010485:Periapical Periodontitis / Q000150:complications* / Q000628:therapy*; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D012388:Root Canal Irrigants / Q000627:therapeutic use; D012390:Root Canal Therapy
chemical_list: D012388:Root Canal Irrigants
keywords: Bacteremia; endodontic treatment; infective endocarditis; prophylactic antibiotic therapy