Bacteremia associated with toothbrushing and dental extraction
Bacteremia associated with toothbrushing and dental extraction
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DOI：
10.1161/circulationaha.107.758524
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发表时间：
2008-06-17
期刊：
影响因子：
37.8
通讯作者：
Bahrani-Mougeot, Farah K.
中科院分区：
文献类型：
--
作者：
Lockhart, Peter B.;Brennan, Michael T.;Bahrani-Mougeot, Farah K.
背景-预防感染性心内膜炎的抗生素预防建议部分基于对牙科手术引起菌血症的研究，但刷牙可能造成更大的威胁。本研究的目的是比较单次拔牙和刷牙引起的心内膜炎相关菌血症的发生率、持续时间、性质和程度，并确定阿莫西林预防对单次拔牙的影响。方法和结果-在这项双盲、安慰剂对照研究中，290名受试者被随机分为（1）刷牙组，（2）单次拔牙联合阿莫西林预防组，或（3）单颗牙拔除与相同的安慰剂。在这些干预之前、期间和之后的6个时间点抽取血液进行细菌培养和鉴定。我们分析的重点是报道引起感染性心内膜炎的细菌种类。我们鉴定了98种细菌，其中32种据报道可引起心内膜炎。刷牙组、拔牙-阿莫西林组和拔牙-安慰剂组6次抽血的心内膜炎相关细菌累积发生率分别为23%、33%和60%（P < 0.0001）。在抽取2、3、4和5时，3组之间鉴定出显著差异（均P < 0.05）。阿莫西林导致阳性培养物显著减少（P < 0.0001）。结论：尽管阿莫西林对单次拔牙引起的菌血症有显著影响，但由于口腔卫生的频率更高，刷牙可能对感染性心内膜炎风险的个体构成更大的威胁。
Background-Antibiotic prophylaxis recommendations for the prevention of infective endocarditis are based in part on studies of bacteremia from dental procedures, but toothbrushing may pose a greater threat. The purpose of this study was to compare the incidence, duration, nature, and magnitude of endocarditis-related bacteremia from single-tooth extraction and toothbrushing and to determine the impact of amoxicillin prophylaxis on single-tooth extraction.Methods and Results-In this double-blind, placebo-controlled study, 290 subjects were randomized to (1) toothbrushing, (2) single-tooth extraction with amoxicillin prophylaxis, or (3) single-tooth extraction with identical placebo. Blood was drawn for bacterial culturing and identification at 6 time points before, during, and after these interventions. The focus of our analysis was on bacterial species reported to cause infective endocarditis. We identified 98 bacterial species, 32 of which are reported to cause endocarditis. Cumulative incidence of endocarditis-related bacteria from all 6 blood draws was 23%, 33%, and 60% for the toothbrushing, extraction-amoxicillin, and extraction-placebo groups, respectively (P < 0.0001). Significant differences were identified among the 3 groups at draws 2, 3, 4, and 5 (all P < 0.05). Amoxicillin resulted in a significant decrease in positive cultures (P < 0.0001).Conclusions-Although amoxicillin has a significant impact on bacteremia resulting from a single-tooth extraction, given the greater frequency for oral hygiene, toothbrushing may be a greater threat for individuals at risk for infective endocarditis.