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• W2212532854 abstract "A recently published paper in this journal elegantly described a study in which venous blood samples were drawn at 6 time-points from individuals undergoing dental manipulation, with the recovered bacterial species cultured and identified by using 16 s ribosomal RNA gene sequencing.1Mougeot F.K. Saunders S.E. Brennan M.T. Lockhart P.B. Association between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction.Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119: 430-435Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar The authors found that the relative frequency of bacterial species associated with the development of infectious endocarditis (IE) did not significantly differ between individuals (n = 98) brushing their teeth and patients (n = 96) having a single tooth extracted without antibiotic prophylaxis. In the same study, these researchers also demonstrated that prophylactic antibiotics (2 g of amoxicillin) administered to patients (n = 96) 1 hour before a single tooth extraction decreased the incidence of bacterial species most commonly associated with IE by 68%. They concluded, however, that although prophylactic antibiotics significantly decreased the incidence of bacteremia, the similarity between the incidence of IE-associated bacteria after brushing and dental extraction without antibiotics undermines the rationale for the administration of prophylactic antibiotics as an effective strategy for the prevention of IE.However, in the literature review, the authors' omission of a project in which they had participated is quite concerning, as this may call into question the validity of their conclusions. I specifically refer to a very recent publication in Lancet entitled “Incidence of infective endocarditis in England, 2000-2013: A secular trend, interrupted time-series analysis.”2Dayer M.J. Jones S. Prendergast B. Baddour L.M. Lockhart P.B. Thornhill M.H. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis.Lancet. 2015; 385: 1219-1228Abstract Full Text Full Text PDF PubMed Scopus (354) Google Scholar In no uncertain terms, this paper documented a temporally related increase in the number of cases of IE in the United Kingdom after the institution of the 2008 National Institute of Health and Clinical Excellence guidance recommending complete cessation of antibiotic prophylaxis for patients with cardiac defects undergoing risk-prone (i.e., bacteremia-inducing) surgical procedures.We believe that the discrepancies in the findings between these 2 studies calls into question the conclusions reached by Mougeot et al1Mougeot F.K. Saunders S.E. Brennan M.T. Lockhart P.B. Association between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction.Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119: 430-435Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar regarding the effectiveness of prophylactic antibiotics in preventing distant-site infections. If nothing else, this calls for further research and reflection. A recently published paper in this journal elegantly described a study in which venous blood samples were drawn at 6 time-points from individuals undergoing dental manipulation, with the recovered bacterial species cultured and identified by using 16 s ribosomal RNA gene sequencing.1Mougeot F.K. Saunders S.E. Brennan M.T. Lockhart P.B. Association between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction.Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119: 430-435Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar The authors found that the relative frequency of bacterial species associated with the development of infectious endocarditis (IE) did not significantly differ between individuals (n = 98) brushing their teeth and patients (n = 96) having a single tooth extracted without antibiotic prophylaxis. In the same study, these researchers also demonstrated that prophylactic antibiotics (2 g of amoxicillin) administered to patients (n = 96) 1 hour before a single tooth extraction decreased the incidence of bacterial species most commonly associated with IE by 68%. They concluded, however, that although prophylactic antibiotics significantly decreased the incidence of bacteremia, the similarity between the incidence of IE-associated bacteria after brushing and dental extraction without antibiotics undermines the rationale for the administration of prophylactic antibiotics as an effective strategy for the prevention of IE. However, in the literature review, the authors' omission of a project in which they had participated is quite concerning, as this may call into question the validity of their conclusions. I specifically refer to a very recent publication in Lancet entitled “Incidence of infective endocarditis in England, 2000-2013: A secular trend, interrupted time-series analysis.”2Dayer M.J. Jones S. Prendergast B. Baddour L.M. Lockhart P.B. Thornhill M.H. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis.Lancet. 2015; 385: 1219-1228Abstract Full Text Full Text PDF PubMed Scopus (354) Google Scholar In no uncertain terms, this paper documented a temporally related increase in the number of cases of IE in the United Kingdom after the institution of the 2008 National Institute of Health and Clinical Excellence guidance recommending complete cessation of antibiotic prophylaxis for patients with cardiac defects undergoing risk-prone (i.e., bacteremia-inducing) surgical procedures. We believe that the discrepancies in the findings between these 2 studies calls into question the conclusions reached by Mougeot et al1Mougeot F.K. Saunders S.E. Brennan M.T. Lockhart P.B. Association between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction.Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119: 430-435Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar regarding the effectiveness of prophylactic antibiotics in preventing distant-site infections. If nothing else, this calls for further research and reflection. The effectiveness of antibiotic prophylaxis in preventing infective endocarditis is not easily dismissedOral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyVol. 120Issue 5PreviewWe appreciate that on a superficial level, the two papers referred to by Dr. Friedlander et al. could be construed as being contradictory. The first paper they cite1 is a secondary analysis of data from a prospective, clinical bacteremia study of 300 randomized patients, published in 2008.2 It focused on the impact of amoxicillin prophylaxis on species of bacteria reported to cause infective endocarditis (IE). The second paper they refer to had not been accepted for publication by the Lancet3 when the first paper was submitted to OOOO. Full-Text PDF Associations between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extractionOral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyVol. 119Issue 4PreviewTo determine the impact of antibiotic prophylaxis (AP) on the incidence of bacteremia caused by oral bacterial species associated with infective endocarditis (IE) and prosthetic joint infections (PJIs) and to compare the incidence of following tooth brushing versus single tooth extraction. Full-Text PDF" @default.
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• W2212532854 title "The effectiveness of antibiotic prophylaxis to prevent infectious endocarditis is not easily dismissed" @default.
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