Risk factors for infective endocarditis: Oral hygiene and nondental exposures

• Published in: Circulation (New York, N.Y.) Vol. 102; no. 23; pp. 2842 - 2848
• Main Authors: STROM, Brian L, ABRUTYN, Elias, BERLIN, Jesse A, KINMAN, Judith L, FELDMAN, Roy S, STOLLEY, Paul D, LEVISON, Matthew E, KORZENIOWSKI, Oksana M, KAYE, Donald
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 05-12-2000; American Heart Association, Inc
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Bacterial endocarditis, myocarditis and pericarditis. Bacterial diseases of the aorta, limb vessels and lymphatic vessels; Barium Sulfate; Biological and medical sciences; Comorbidity; Delaware - epidemiology; Diabetes Complications; Diabetes Mellitus - epidemiology; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - etiology; Enema - adverse effects; Environmental Exposure; Female; Fluid Therapy - adverse effects; Heart Valve Diseases - complications; Heart Valve Diseases - epidemiology; Heart Valve Diseases - surgery; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis - microbiology; Human bacterial diseases; Humans; Infectious diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - epidemiology; Logistic Models; Male; Medical sciences; Middle Aged; Oral Hygiene - methods; Oral Hygiene - standards; Oxygen Inhalation Therapy - adverse effects; Pennsylvania - epidemiology; Risk Factors; Skin - microbiology; Skin Diseases - complications; Skin Diseases - epidemiology; Skin Diseases - microbiology; Delaware; Pennsylvania; Human; Oral cavity; Heart disease; Endocardial disease; Endocarditis; Risk factor; Cardiovascular disease; Hygiene
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.102.23.2842

The risks of infective endocarditis (IE) associated with various conditions and procedures are poorly defined.
This was a population-based case-control study conducted in 54 Philadelphia, Pa-area hospitals from 1988 to 1990. Community-acquired IE cases unassociated with intravenous drug use were compared with matched community residents. Subjects were interviewed for risk factors. Diagnoses were confirmed by expert review of medical record abstracts with risk factor data removed. Cases were more likely than controls to suffer from prior severe kidney disease (adjusted OR [95% CI]=16.9 [1.5 to 193], P:=0.02) and diabetes mellitus (adjusted OR [95% CI]=2.7 [1.4 to 5.2], P:=0.004). Cases infected with skin flora had received intravenous fluids more often (adjusted OR [95% CI]=6.7 [1.1 to 41], P:=0.04) and had more often had a previous skin infection (adjusted OR [95% CI]=3.5 [0.7 to 17], P:=0.11). No association was seen with pulmonary, gastrointestinal, cardiac, or genitourinary procedures or with surgery. Edentulous patients had a lower risk of IE from dental flora than patients who had teeth but did not floss. Daily flossing was associated with a borderline decreased IE risk.
Within the limits of the available sample size, the data showed that IE patients differ from people without IE with regard to certain important risk factors but not regarding recent procedures.