Infective Endocarditis Caused by Oral Microorganisms and Entrance Door and Previous Dental Procedures: Does a Relationship Exists?

Abstract

There are no recent studies that have evaluated the epidemiological relationship between dental manipulations the etiology of IE by these microorganisms, basically Streptococcus viridans. Our objective is to analyse the relationship between these variables and the possible therapeutic implications. For this, we have analysed a prospective single-center series of IE in patients not addicted to parenteral drugs collected and followed between 1987 and 2018. 403 cases of native and late prosthetic IE were diagnosed and followed up in our center. Of them, 91 were produced by oral streptococci (22.6%). The percentage of this microorganism has remained constant throughout the 30 years (24.8% of the cases from 1987-1997, 25% of those from 1998-2007 and 19.1% from 2008-2018. Although there was a history of dental manipulation in a greater proportion in cases of IE due to Streptococcus viridans (24% vs. 6.5%, p <0.001), in most cases due to Streptococcus viridans (76% of them) there was no previous dental manipulation. In these cases, the infection may be due to the usual daily manipulations of the mouth (brushing, dental floss) or periodontal disease. Given this low sensitivity, it cannot be ruled out that IE is caused by this microorganism in the absence of a history of visiting the dentist, with the implications for empirical antibiotic treatment that this entails