Evaluating the impact of 2008 NICE dental prophylaxis guidelines on surgically treated infective endocarditis: a...

In 2008, the National Institute for Health and Care Excellence (NICE) recommended cessation of antibiotic prophylaxis for at-risk patients undergoing dental procedures (CG64). This study aimed to evaluate the impact of these guidelines on the incidence, microbiological profile, and surgical characteristics of infective endocarditis (IE) requiring operative intervention.

A retrospective analysis was performed using a prospectively maintained surgical database to identify all cases of surgically treated IE at a UK cardiothoracic centre from 2004 to 2023. Patients were stratified into pre- and post-2008 cohorts. Temporal trends in surgical IE incidence were evaluated alongside changes in microbiology, valve involvement, urgency of surgery, and proportion of dental-related organisms. Statistical comparisons included Welch's t-test, Fisher's Exact Test, chi-squared analysis, and Poisson regression.

A total of 313 surgical IE cases were identified (41 pre-2008, 272 post-2008). Mean annual incidence rose from 10.0 pre-2008 to 18.1 post-2008 cases per year. Poisson regression demonstrated a significantly higher incidence post-2008 (incidence rate ratio [IRR] 1.81, 95% CI 1.30-2.53, p < 0.001). The odds of dental-associated pathogens were unchanged (OR 0.65, 95% CI 0.24-1.74, p = 0.39). Staphylococcus aureus predominated in the later cohort, while the proportion of oral streptococci remained stable. Surgical characteristics, including prosthetic valve involvement (OR 1.61, 95% CI 0.78-3.29, p = 0.20) and urgency (OR 0.89, 95% CI 0.35-2.27, p = 0.81), were similar between groups.

The 2008 NICE recommendation to discontinue dental antibiotic prophylaxis was associated with a significant rise in surgically managed IE at our centre. However, the microbiological and surgical profiles of IE remained consistent, with no increase in cases attributable to oral streptococci. These findings suggest that factors beyond dental prophylaxis may concomitantly contribute to the observed rise in surgical IE.