Oral Hygiene, Periodontal Disease, and Infective Endocarditis

描述（由申请人提供）：感染性心内膜炎（IE）是一种发病率高、可导致死亡的疾病。医疗保健相关（HCA）IE通常由非口腔葡萄球菌引起，与心脏手术、血管内导管和心脏器械相关。相比之下，社区获得性（CA）IE通常是由于预先存在心脏瓣膜异常的患者中的链球菌。先前的研究提供了一些证据表明，牙周组织及其生物膜可能是导致CA-IE的菌血症的重要来源。然而，没有良好的对照研究直接调查牙周病，牙周细菌和CA-IE的关联。这项多中心病例对照研究的目的1是确定口腔卫生不良、牙龈炎或牙周炎是否与任何细菌引起的感染性心内膜炎有关。为了实现这一目标，将在112例最近住院的CA-IE患者（病例）和224例来自周围社区的健康患者（对照组）中比较口腔卫生、牙龈炎和牙周炎的标准化措施，这些患者具有CA-IE的心血管危险因素，但没有这种疾病。目标2将确定口腔卫生不良、牙龈炎或牙周炎是否与由通常与口腔卫生不良或牙周疾病相关的细菌引起的感染性心内膜炎相关。为了实现这一目标，将在具有通常驻留在口腔中的口腔细菌的阳性血培养的CA-IE病例患者和特定目标1的对照患者之间比较口腔卫生、牙龈炎和牙周炎。目标3将确定口腔卫生不良、牙龈炎或牙周炎是否与感染性心内膜炎有关，感染性心内膜炎由通常与口腔卫生不良或牙周病无关的细菌引起。为了实现这一目标，将对非口腔细菌血培养呈阳性的CA-IE病例患者和特定目标1的对照患者的口腔卫生、牙龈炎和牙周炎进行比较。如果在临床和统计学上发现不良口腔卫生，牙龈炎或牙周病与CA-IE之间存在显着关联，这项研究将改变我们对CA-IE风险因素的理解，并将向前迈出重要一步，因为它将提供支持证据，改善口腔卫生和保持牙周健康可能会降低CA-IE的风险。这有可能降低CA-IE的发病率及其相关的发病率、死亡率和成本。它将为未来预防心内膜炎的临床指南提供重要信息，并为美国和全世界所有感染性心内膜炎风险人群的公共卫生做出重要贡献。

DESCRIPTION (provided by applicant): Infective endocarditis (IE) is a disease with a high degree of morbidity that can result in death. Healthcare- associated (HCA) IE is often due to non-oral staphylococcal bacteria and is associated with cardiac surgery, intravascular catheters, and cardiac devices. In contrast, community-acquired (CA) IE is typically due to streptococci in patients with pre-existing heart valve abnormalities. Prior studies provide some evidence that the periodontium and its biofilm may be a significant source of the bacteremia that results in CA-IE. However, no well-controlled studies have directly investigated the association of periodontal disease, periodontal bacteria, and CA-IE. Aim 1 of this multi-center case-control study is to determine if poor oral hygiene, gingivitis or periodontitis is associated with infective endocardits caused by any bacterial species. To address this aim, standardized measures of oral hygiene, gingivitis and periodontitis will be compared in 112 recently hospitalized patients with CA-IE (cases) and 224 healthy patients from the surrounding community who have cardiovascular risk factors for CA-IE but have not had the disease (controls). Aim 2 will determine if poor oral hygiene, gingivitis or periodontitis is associated with infective endocarditis caused by bacteria that ARE typically associated with poor oral hygiene or periodontal diseases. To address this aim, oral hygiene, gingivitis, and periodontitis will be compared among case patients with CA-IE who have positive blood cultures for oral bacteria that typically reside in the oral cavity and control patients from specific Aim 1. Aim 3 will determine if poor oral hygiene, gingivitis or periodontitis is associated with infective endocarditis caused by bacteria that ARE NOT typically associated with poor oral hygiene or periodontal disease. To address this aim, oral hygiene, gingivitis, and periodontitis will be compared among case patients with CA-IE who have positive blood cultures for non-oral bacteria and control patients from Specific Aim 1. If clinically and statistically significant associations are found between poor oral hygiene, gingivitis or periodontal disease and CA-IE, this study will transform our understanding of risk factors for CA-IE and will be a major step forward because it will provide supporting evidence that improving oral hygiene and maintaining periodontal health may reduce the risk for CA-IE. This has the potential to reduce the incidence of CA-IE and its associated morbidity, mortality, and cost. It would provide important information for future clinical guidelines for the prevention of endocarditis and be an important contribution to the public health in the U.S. and throughout the world for all people at risk for infective endocarditis.