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.

中文翻译：

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瑞典草丛链球菌引起的感染性心内膜炎的发病率——牙科中停止使用抗生素预防对高危人群的影响

摘要

介绍

2012 年 10 月，瑞典医疗产品局发布了关于在牙科中停止使用预防性抗生素以预防感染性心内膜炎 (IE) 的新建议。以前，对于有瓣膜假体、复杂心脏瓣膜疾病和既往心内膜炎的患者，将在侵入性牙科手术前 1 小时口服 2 克阿莫西林。

目标

本研究的目的是评估在瑞典引入新建议后，由口腔草绿色群链球菌 (VGS) 或由葡萄球菌引起的 IE 的总发病率是否增加。

方法

使用中断时间序列分析计算和比较 2012 年 10 月前后瑞典的 IE 发病率。对 IE 的总发病率和由 VGS 或金黄色葡萄球菌引起的 IE 进行了单独分析。IE 病例是使用瑞典国家 IE 登记处确定的，该登记处自 1995 年以来一直存在，包含来自瑞典所有专门从事传染病的医院诊所的数据。入院日期为 2008 年 1 月 1 日至 2017 年 12 月 31 日的所有病例^均包括^在内。使用瑞典政府机构瑞典统计局的数据，根据人口规模的年度变化对发病率计算进行了校正。

结果

结果显示，与之前相比，2012 年 10 月之后瑞典普通人群中 IE、由 VGS 或金黄色葡萄球菌引起的 IE 总发病率趋势线的斜率没有显着增加。

结论

结果表明，为预防牙科 IE 而建议停止使用预防性抗生素并未导致瑞典人群中由口腔链球菌引起的 IE 发病率增加。