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. (2024) ‘Antibiotic prophylaxis and infective endocarditis incidence following invasive dental procedures’, JAMA Cardiology, 9(7), p. 599. doi:10.1001/jamacardio.2024.0873.
Background
Infective endocarditis (IE) is a life-threatening infection of the heart valves and endocardium, often caused by bacteria entering the bloodstream during invasive dental procedures (IDPs). Patients with pre-existing heart conditions, such as congenital heart disease, prosthetic heart valves, or previous endocarditis, are at higher risk of developing IE. Antibiotic prophylaxis (AP) maybe required for the non-routine management for these high-risk individuals before undergoing IDPs to prevent bacterial infections that may lead to IE. However, the effectiveness of AP in reducing IE incidence has been widely debated.
Methods
The study by Sperotto et al. is a systematic review and meta-analysis, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A comprehensive search of several databases, including PubMed, Cochrane Library, and Embase, were conducted to identify relevant literature. Study selection was performed by two independent reviewers, with disagreements resolved by a third reviewer. Data from eligible studies were extracted and pooled for meta-analysis. The review focused on clinical studies that investigated the impact of AP on IE incidence following IDPs. Randomized controlled trials (RCTs), cohort studies, and case-control studies published in peer-reviewed journals were included until May 2023.
Results
- The review included 30 studies, across 8 countries encompassing a total of 1152345 IE cases.
- The meta-analysis revealed that individual at high risk who received AP before IDPs were 59% (95% CI, 43-71) less likely to develop infective endocarditis compared to those who did not receive antibiotic prophylaxis.
- In the time trend analysis, 9 studies showed no significant changes, 7 noted an increase and 3 observed a decrease in IE incidence.
Conclusion
This systematic review and meta-analysis indicate that AP significantly reduces the risk of IE in high-risk individuals undergoing IDPs. The GRADE assessment suggests that the quality of evidence supporting AP use is moderate, highlighting the need for further high-quality, large-scale Randomised Controlled Trials to confirm the findings and strengthen the recommendation for AP in specific patient populations. However, the major challenge of the trial feasibility is the ethical concerns around withholding AP from at risk population.
Research Summary Written By: Neha Thomas, University of Dundee, BDS