ImportanceThe association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007.ObjectiveTo systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures.Data SourcesPubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023.Study SelectionStudies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included.Data Extraction and SynthesisStudy quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis.Main Outcomes and MeasuresThe outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis.ResultsOf 11 217 records identified, 30 were included (1 152 345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity = .51; I2, 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci–infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis.Conclusions and RelevanceWhile results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.

中文翻译：

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侵入性牙科手术后抗生素预防和感染性心内膜炎发病率

重要性 抗生素预防与侵入性牙科手术后感染性心内膜炎之间的关系仍不清楚。从 2007 年开始，抗生素预防的适应症受到指南的限制。目的系统回顾和分析关于侵入性牙科手术后抗生素预防与感染性心内膜炎之间关系的现有证据。数据来源PubMed、Cochrane-CENTRAL、Scopus、Web of Science、Proquest、Embase、从开始到 2023 年 5 月，对牙科和口腔科学来源和 ClinicalTrials.gov 进行了系统检索。研究选择研究侵入性牙科手术后抗生素预防与感染性心内膜炎之间的关联，或当前抗生素预防指南前后感染性心内膜炎发病率的时间趋势分析数据提取和综合使用结构化工具评估研究质量。数据由独立观察员提取。通过随机效应荟萃分析计算了接受抗生素预防的个体与未接受抗生素预防的个体在侵入性牙科手术后发生感染性心内膜炎的汇总相对风险（RR）。主要结果和措施感兴趣的结果是感染性心内膜炎的发生率与抗生素预防相关的侵入性牙科手术后。结果 在已识别的 11 217 份记录中，纳入了 30 份（1 152 345 例感染性心内膜炎病例）。其中，8项（包括12项亚研究）为病例对照/交叉或队列研究或自我对照病例系列研究，22项为时间趋势研究；一切都质量很好。 12 项采用病例对照/交叉、队列或自我对照病例系列设计的子研究中有 8 项进行了正式的统计分析； 5 名支持抗生素预防的保护作用，特别是对于高危人群，而 3 名则不支持。通过荟萃分析，抗生素预防与高危个体侵入性牙科手术后感染性心内膜炎的风险显着降低相关（汇总 RR，0.41；95% CI，0.29-0.57；磷异质性 = .51；我2, 0%)。 22 项时间趋势研究中有 19 项进行了正式的前后统计分析； 9 人发现感染性心内膜炎发病率没有显着变化，7 人发现总体人群或亚人群（高风险和中度风险个体、链球菌感染性心内膜炎和草绿色链球菌感染性心内膜炎）发病率显着增加，而 3 人发现感染性心内膜炎发病率显着下降。结论和相关性虽然时间趋势研究的结果不一致，但病例对照/交叉、队列和自我对照病例系列研究的数据表明，使用抗生素预防与减少感染相关。高风险个体在侵入性牙科手术后感染性心内膜炎的风险较高，而低风险/未知风险个体没有相关性，从而支持当前美国心脏协会和欧洲心脏病学会的建议。目前，没有足够的数据支持抗生素预防对中度风险个体有任何益处。