Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis
Issued Date
2024-01-01
Resource Type
ISSN
23806583
eISSN
23806591
Scopus ID
2-s2.0-85190267370
Pubmed ID
38581643
Journal Title
JAMA Cardiology
Rights Holder(s)
SCOPUS
Bibliographic Citation
JAMA Cardiology (2024)
Suggested Citation
Sperotto F., France K., Gobbo M., Bindakhil M., Pimolbutr K., Holmes H., Monteiro L., Graham L., Hong C.H.L., Sollecito T.P., Lodi G., Lockhart P.B., Thornhill M., Diz Dios P., Turati F., Edefonti V. Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis. JAMA Cardiology (2024). doi:10.1001/jamacardio.2024.0873 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98049
Title
Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis
Author's Affiliation
Faculty of Medicine, Dentistry and Health
Faculty of Dentistry
Augusta University
Instituto Universitário de Ciências da Saúde (IUCS)
University of the Western Cape
Wake Forest University School of Medicine
Università degli Studi di Milano
Universidad de Santiago de Compostela
Mahidol University
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
University of Pennsylvania
Harvard Medical School
Ca' Foncello Hospital
Faculty of Dentistry
Augusta University
Instituto Universitário de Ciências da Saúde (IUCS)
University of the Western Cape
Wake Forest University School of Medicine
Università degli Studi di Milano
Universidad de Santiago de Compostela
Mahidol University
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
University of Pennsylvania
Harvard Medical School
Ca' Foncello Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Importance: The association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007. Objective: To systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures. Data Sources: PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023. Study Selection: Studies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included. Data Extraction and Synthesis: Study quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis. Main Outcomes and Measures: The outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis. Results: Of 11217 records identified, 30 were included (1152345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity =.51; I2, 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci-infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis. Conclusions and Relevance: While results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.