Another Look at Antimicrobial Prophylaxis for Dental Procedures in Patients with Prosthetic Heart Valves

The benefit of antimicrobial prophylaxis against bacterial endocarditis in patients with prosthetic heart valves remains controversial. Recent guidelines both in the U.S. and abroad have limited the number of risk factors associated with potential prophylaxis benefit. Now, researchers have conducted a population-based cohort and case crossover study that is the largest to date examining antibiotic prophylaxis for dental procedures in patients with prosthetic heart valves. The study included all adults aged ≥18 living in France who had procedure codes for positioning or replacing prosthetic heart valves between 2008 and 2014, amounting to 138,876 patients with 285,034 patient-years of follow-up. Of these, 49.9% had at least one dental procedure, 26% of which were deemed invasive.

Compared with patients without a dental procedure, in those with invasive procedures without antibiotic prophylaxis, there was a trend for an increase in endocarditis (adjusted odds ratio, 1.57; 95% confidence interval, 0.9–2.53; P=0.08). For those with invasive procedures who received prophylaxis, the adjusted odds ratio was a nonsignificant 0.83 (95% CI, 0.33–1.69; P= 0.65). In the crossover analysis, invasive dental procedures were significantly more common in the 3 months before endocarditis than in control time periods (5.1% vs. 3.2%; odds ratio, 1.66). However, the odds of infective endocarditis with invasive procedures were the same with or without antibiotic prophylaxis (1.69 and 1.62, respectively).