Assessment of endocarditis prophylaxis knowledge and attitudes among healthcare practitioners in Tehran and Hamadan.

BACKGROUND: Having knowledge of the dental procedures that necessitate endocarditis prophylaxis is of high importance. Therefore, the aim of the present study was to determine the knowledge level and attitudes of general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan about endocarditis. METHODS: This cross-sectional study was carried out on 420 general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan provinces in 2015. The questionnaire used in this research consisted of three parts as follows: part one: information on cardiac diseases; part two: dental procedures requiring endocarditis prophylaxis; part three: antibiotic diet in endocarditis prophylaxis. Independent t-test, one-way ANOVA, and chi-square tests were conducted to analyze the data. All the analyses were performed in SPSS version 16. RESULTS: The results showed that 86.7 had a relatively favorable and 10.5% of subjects had a favorable level of knowledge about endocarditis. Also, 58.6% of subjects had a poor attitude toward endocarditis prophylaxis. There was a significant relationship between knowledge and attitude, age, gender, and work experience (P < 0.001). There was a significant relationship between knowledge and attitude, and job groups; dental specialists had a more favorable knowledge and positive attitude than others (P < 0.001). CONCLUSION: We recommended developing more practical training programs in dental schools on cardiac diseases, and dental procedures requiring endocarditis prophylaxis and antibiotic diets.

[Infectious endocarditis: from epidemiology to prevention]. / Endocardites infectieuses : de l'épidémiologie à la prévention.

INFECTIOUS ENDOCARDITIS: FROM EPIDEMIOLOGY TO PREVENTION. The incidence of infective endocarditis is estimated between 30 and 80 cases per million inhabitants and per year in the general population in industrialized countries. It is heterogeneous and increases sharply in the presence of certain underlying heart diseases; it exceeds 1% per year in patients with a history of endocarditis. Incidence increases after the age of 60 and Staphylococcus is now the most frequent responsible microorganism. Antibiotic prophylaxis is indicated only in the patients who are at high risk of infective endocarditis and who undergo invasive dental care. The recommendations published in 2023 by the European Society of Cardiology highlig.

ENDOCARDITES INFECTIEUSES: DE L'ÉPIDÉMIOLOGIE À LA PRÉVENTION. L'incidence de l'endocardite infectieuse est estimée entre 30 et 80 cas par million d'habitants et par an en population générale dans les pays industrialisés. Cette incidence est hétérogène et augmente très nettement dans certaines cardiopathies sous-jacentes : elle dépasse 1 % par an chez les patients ayant un antécédent d'endocardite. L'incidence est majorée après 60 ans, et le staphylocoque est désormais la bactérie la plus souvent en cause. L'antibioprophylaxie n'est indiquée que chez les patients ayant un risque élevé d'endocardite infectieuse et soumis à des soins dentaires invasifs. Les recommandations publiées en 2023 par l'European Society of Cardiology soulignent l'importance des mesures non spécifiques d'hygiène bucco-dentaire et cutanée dans la prévention.

Infective Endocarditis: Etiology, Epidemiology and Current Recommendations for the Dental Practitioner.

Infective endocarditis (IE) remains one of the most serious diseases with a high morbidity and mortality rate. Although the condition is more common in the medical field in a hospital setting, dentists must have a thorough understanding of the overall pathogenesis, epidemiology, risk factors and signs and symptoms that may be present in their patient population. In 2021, the American Heart Association (AHA) updated its guidelines on IE, emphasizing the specific criteria that put a patient at risk of acquiring IE, specific dental procedures that can increase the risk of IE by inducing bacteremia and an antibiotic prophylaxis regimen to act as a preventive measure if needed. This literature review gives the dental practitioner a general overview of the AHA guidelines as well as information on prevention in their at-risk patients and the need to emphasize a well-structured, consistent daily oral hygiene routine.

Prevention of infective endocarditis in at-risk patients: how should dentists proceed in 2024?

National Institute for Health and Care Excellence (NICE) guidelines are ambiguous over the need for patients at increased risk of infective endocarditis (IE) to receive antibiotic prophylaxis (AP) prior to invasive dental procedures (IDPs), and this has caused confusion for patients and dentists alike. Moreover, the current law on consent requires clinicians to ensure that patients are made aware of any material risk they might be exposed to by any proposed dental treatment and what can be done to ameliorate this risk, so that the patient can decide for themselves how they wish to proceed. The aim of this article is to provide dentists with the latest information on the IE-risk posed by IDPs to different patient populations (the general population and those defined as being at moderate or high risk of IE), and data on the effectiveness of AP in reducing the IE risk in these populations. This provides the information dentists need to facilitate the informed consent discussions they are legally required to have with patients at increased risk of IE about the risks posed by IDPs and how this can be minimised. The article also provides practical information and advice for dentists on how to manage patients at increased IE risk who present for dental treatment.

Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis.

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 11 217 records identified, 30 were included (1 152 345 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.

Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines.

PURPOSE OF REVIEW: The question of antibiotic prophylaxis and its role in prevention of infective endocarditis (IE) remains controversial, with differing recommendations from international societies. The aim of this review was to compare and contrast current recommendations on antibiotic prophylaxis for IE by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) and highlight the evidence supporting these recommendations. RECENT FINDINGS: International guidelines for administration of antibiotic prophylaxis for prevention of IE are largely unchanged since 2009. Studies on the impact of the more restrictive antibiotic prophylaxis recommendations are conflicting, with several studies suggesting lack of adherence to current guidance from the ESC (2015), NICE (2016), and AHA (2021). The question of antibiotic prophylaxis in patients with IE remains controversial, with differing recommendations from international societies. Despite the change in guidelines more than 15 years ago, lack of adherence to current guidelines persists. Due to the lack of high-quality evidence and the conflicting results from observational studies along with the lack of randomized clinical trials, the question of whether to recommend antibiotic prophylaxis or not in certain patient populations remains unanswered and remains largely based on expert consensus opinion.

Infective endocarditis: prevention strategy and risk factors in an animal model.

INTRODUCTION: Infective endocarditis is a serious infection of the endocardium, especially the heart valves, which is associated with a high mortality rate. It generally occurs in patients with altered and abnormal cardiac architecture combined with exposure to bacteria from trauma and other potentially high-risk activities with transient bacteremia.

Relevancia de profilaxis antibiótica ante procedimientos dentales generadores de bacteriemias transitorias / Antimicrobial prophylaxis for transient bacteremia during dental procedures

This review examines the evidence about the relationship between dental procedures and the incidence of transient bacteremia. One of the main obstacles was to define "invasive dental procedure" as an indication for antimicrobial prophylaxis for patients with high risk of bacteremia. A search in WorldWideScience and ScienceDirect was performed and 20 articles were selected for review. Two contradictions stood out. There is no concrete evidence that a transient bacteremia arising during a dental procedure may be a risk factor for the appearance of bacterial endocarditis. There is no certainty about the effectiveness of antimicrobial prophylaxis, due to the lack of clinical trials of good quality. There is a similitude between bacteremia resulting from invasive and non-invasive dental procedures. The importance of periodontal health as a preventive measure for bacterial endocarditis among high risk patients is highlighted.

Conhecimento dos pais sobre profilaxia de endocardite infecciosa em crianças portadoras de cardiopatias congênitas / Parents' knowledge of infective endocarditis in children with congenital heart disease

INTRODUÇÃO: As diretrizes para profilaxia de endocardite infecciosa mudaram, mas muitas cardiopatias congênitas seguem sendo consideradas de alto risco para o desenvolvimento da doença. OBJETIVO: Avaliar o conhecimento dos pais ou responsáveis pelas crianças e adolescentes portadores de cardiopatias atendidos em um serviço de referência no estado do Rio Grande do Sul, Brasil, sobre endocardite infecciosa e sua profilaxia. MÉTODOS: Estudo transversal com 90 pacientes portadores de cardiopatias congênitas em acompanhamento ambulatorial regular. O conhecimento dos pais foi avaliado com o uso de questionário específico e os demais dados foram obtidos por meio da revisão de prontuários. RESULTADOS: A mediana da idade dos pacientes foi de 5,6 anos (3 meses - 14 anos e 7 meses), sendo 57,7% do sexo masculino. A mediana de tempo de acompanhamento no serviço foi de 3,49 anos (1,20-7,38 anos). Os anos de estudo formal dos pais apresentaram média de 7,67 ± 3,25 anos. De acordo com o escore previamente estabelecido, o conhecimento dos pais entrevistados foi considerado satisfatório em 37,7% dos casos, regular, em 33,3% e insatisfatório, em 28,8%. Houve correlação significativa entre o índice de conhecimento dos pais e tempo de acompanhamento das crianças no serviço (r=0,584; P<0,001). Não houve correlação entre a escolaridade dos pais e o conhecimento dos mesmos (r=0,028; P=0,796). CONCLUSÃO: O conhecimento dos pais sobre endocardite e sua profilaxia mostrou-se inadequado, requerendo maior atenção nas orientações transmitidas nas consultas.

INTRODUCTION: The guidelines to prophylaxis of infectious endocarditis changed, but many congenital heart diseases continue to be considered as high risk for the development of the disease. OBJECTIVE: To evaluate the knowledge of parents or guardians of children and adolescents with congenital heart disease seen at a referral center in Rio Grande do Sul, Brazil on infective endocarditis and its prevention. METHODS: Cross-sectional study with 90 patients with congenital heart defects in regular outpatient treatment. The parents' knowledge was assessed using a specific questionnaire and other data were obtained through medical records. RESULTS: The median age of patients was 5.6 years (3 months -14 years), being 57,7% males. The median follow-up time in service was 3.49 years (1.20-7.38). The years of formal schooling of the parents had a mean of 7.67 ± 3.25 years. According to the score previously established, the knowledge of the interviewed parents was considered satisfactory in 37.7%, regular in 33.3% and unsatisfying in 28,8%. There was significant correlation between the index of parents' knowledge and monitoring of children at service (r=0.584; P=0.796). There was no correlation between parents' education and knowledge of them (r=0.028; P=0.796). CONCLUSION: The parents' knowledge about endocarditis and its prevention was inadequate, requiring greater attention to the orientations passed in consultations.

Abordagem odontológica de pacientes com risco de endocardite: um estudo de intervenção / Approach of dental patients with risk of endocarditis: an intervention study

Determinar a percepção dos Cirurgiões-dentistas da Estratégia de Saúde da Família do município de Campina Grande-PB na abordagem de pacientes com risco de endocardite bacteriana.Material e método: foi um estudo de intervenção “antes e após”, no qual participaram 33 profissionais. Utilizou-se um formulário semi-estruturado contendo 6 questões sobre o assunto, aplicados em dois momentos, antes e após palestra informativa, sendo esta etapa realizada após 30 dias. O teste estatístico usado foi o McNemar com o nível de significância de 5%.Resultados: de uma maneira geral, os profissionais tinham conhecimento do conceito da endocardite, sendo este elevado após palestra (97% x 100%). O percentual de profissionais que interage com os médicos foi alto e não se alterou após a palestra (72,7%). O regime profilático foi descrito corretamente, nas duas etapas da pesquisa por 39,4% e 90,9%, respectivamente, dos profissionais. As condições necessárias para a administração de antimicrobianos foi elevada de 48,5% para 90%, no segundo questionamento.Conclusão: a palestra informativa aumentou o conhecimento dos profissionais sobre o assunto, e, a universidade, como formadora de opinião deve participar da educação continuada dos profissionais contribuindo para a resolução de nós críticos vivenciados pelos serviços locais de saúde...

Determine the perception of dentists of the Family Health Strategy Program (Federal Government) in Campina Grande-PB in the approach to patients with risk for bacterial endocarditis. Methodology: it was a "before and after" intervention study in which 33 professionals were interviewed. We used a semi-structured questionnaire containing 14 questions on the subject, applied on two occasions, before and after an informative lecture, this step being performed after 30 days. The statistical test used was the McNemar test with a significance level of 5%. Results: in general, professionals were aware of the concept of endocarditis, which was higher after the lecture (97% versus 100%). The percentage of professionals who interacted with doctors was high and did not change after the lecture (72.7%). The prophylactic regimen was described properly in both interviews, by 39.4% and 90.9% of respondents, respectively. The needed conditions for the administration of antibiotics was increased from 48.5% to 90%. Conclusion: the informative lecture increased the knowledge of professionals on the subject and the university, as an opinion maker, must participate in continuing education of professionals contributing to the resolution of critical problems experienced by local health services...

Evolução das alterações e atualizações do protocolo 2007 da American Heart Association para prevenção da endocardite infecciosa / Evolution of amendments and updates of 2007 protocol of the American Heart Association for prevention of infective endocarditis

Determinados procedimentos odontológicos podem causar bacteremia transitória. Pacientes com condições cardíacas de risco podem desenvolver endocardite infecciosa. Há décadas a American Heart Association (AHA) estabelece recomendações sobre procedimentos odontológicos e condições cardíacas de risco para endocardite, as quais devem receber profilaxia antibiótica. O propósito desta revisão foi descrever a evolução das alterações e divulgar as novas recomendações da AHA para a prevenção da endocardite infecciosa, publicadas em 2007.

Some dental procedures can cause transient bacteremia that in patients with risk cardiac conditions can evolve to infective endocarditis. For decades the American Heart Association (AHA) has been establishing recommendations about the dental procedures and cardiac conditions that bring risk for infective endocarditis, which must receive antibiotic prophylaxis. The purpose of this study is to describe the evolution of the changes and disseminate the new recommendations by the AHAfor the prevention of infective endocarditis which was published in 2007.

Assistência odontológica em portadores de síndrome de Down com alterações cardiológicas / Dental assistance to Down syndrome patients with congenital heart malformations

Cirurgiões-dentistas devem conhecer o diagnóstico cardiológico de seus pacientes antes de qualquer tratamento que possa causar sangramento, uma vez qua a profilaxia antibiótica deve ser feita para evitar endocardite infecciosa. Neste estudo os autores apresentam a frequência e os tipos de cardiopatias congênitas em pacientes com síndrome de Down e enfatizam a prevenção de endocardite infecciosa com profilaxia antibiótica adequada...

A importância da promoção de saúde bucal para a criança cardiopata / The importance of oral health promotion towards children with heart disease

A relação entre os microorganismos bucais e o risco de endocardite infecciosa em pacientes portadores de cardiopatias é bastante conhecida. A higiene bucal deficiente e as más condições dentárias destes pacientes resultam em bacteremias frequentes o que os coloca em risco permanente de desenvolver endocardite infecciosa. Este artigo tem como objetivo enfatizar, por meio de revisão da literatura, a inclusão do odontopediatria na equipe multidisciplinar que presta atendimento a crianças cardiopatas, priorizando o papel de educador em saúde bucal.

Prevención de endocarditis infecciosa en odontología: nuevas recomendaciones año 2007 sobre profilaxis antibiótica / Prevention of infectious endocarditis in dentistry: new recommendations on antibiotic prophylaxis, year 2007

Revisión y sumarización del artículo sobre prevención de endocarditis infecciosa en odontología.

Prevención de endocarditis infecciosa en odontología / Prevention of infectious endocarditis in dentistry

Revisión y sumarización del artículo sobre prevención de endocarditis infecciosa en odontología.