Incidence of infective endocarditis caused by viridans group streptococci in Sweden - effect of cessation of antibiotic prophylaxis in dentistry for risk individuals

Niko Vähäsarja; Bodil Lund; Anders Ternhag; Bengt Götrick; Lars Olaison; Margareta Hultin; Carina Krüger Weiner; Aron Naimi-Akbar

doi:10.1080/20002297.2020.1768342

Incidence of infective endocarditis caused by viridans group streptococci in Sweden - effect of cessation of antibiotic prophylaxis in dentistry for risk individuals

J Oral Microbiol. 2020 May 23;12(1):1768342. doi: 10.1080/20002297.2020.1768342.

Authors

Niko Vähäsarja^{1

2}, Bodil Lund^{1

3

4}, Anders Ternhag⁵, Bengt Götrick⁶, Lars Olaison⁷, Margareta Hultin¹, Carina Krüger Weiner^{1

2}, Aron Naimi-Akbar^{1

2

8}

Affiliations

¹ Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
² Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet.
³ Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
⁴ Department of Oral and Maxillofacial Surgery, Haukelands University Hospital, Bergen, Norway.
⁵ Department of Medicine Solna, Karolinska Institutet, Unit for Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁶ Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö, Sweden.
⁷ Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Sweden.
⁸ Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden.

Abstract

Introduction: In October 2012, the Swedish Medical Products Agency published new recommendations for the cessation of prophylactic antibiotics in dentistry for the prevention of infective endocarditis (IE). Previously, 2 g of amoxicillin per os would be administered 1 h before invasive dental procedures to patients with valve prosthesis, complicated heart valve disease, and to those with previous endocarditis.

Objectives: The aim of this study was to evaluate whether the total incidence of IE caused by oral viridans group streptococci (VGS) or IE caused by staphylococci, increased in Sweden after the introduction of the new recommendations.

Methods: The incidence of IE in Sweden before and after October 2012 was calculated and compared using an interrupted time series analysis. Separate analyses were conducted for the total incidence of IE, and IE caused by VGS or Staphylococcus aureus. Cases of IE were identified using the Swedish national registry of IE, which has existed since 1995 and contains data from all Swedish hospital clinics specialising in infectious disease. All cases with hospital admission date from the 1^st of Jan 2008, to the 31^st of Dec 2017 were included. The incidence calculations were corrected for annual changes in population size using data from the Swedish government agency Statistics Sweden.

Results: The results show no statistically significant increase in the slope of the trend line of the total incidence of IE, IE caused by VGS or S. aureus in the Swedish general population after October 2012, compared to before.

Conclusion: The results suggest that the recommended cessation of prophylactic antibiotics for the prevention of IE in dentistry has not led to an increased incidence of IE caused by oral streptococci among the Swedish population.

Keywords: Prophylactic antibiotics; dentistry; infective endocarditis; viridans group streptococci.

Grants and funding

Funding was provided by the board of doctoral education at Karolinska Institutet, the Public Health Agency of Sweden, Folktandvården Stockholm AB, Steering Group for Collaborative Odontological Research at Karolinska Institutet and Stockholm City County, and the Swedish Dental Association.