侵襲的な歯科治療後の感染性内心炎のリスク: 単独症例研究
Tzu-Ting Chen1, Yi-Chun Yeh1,2, Kuo-Liong Chien1,3,4
1Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei (T.-T.C., Y.-C.Y., K.-L.C., M.-S.L., Y.-K.T.).
Circulation
|April 21, 2018
まとめ
侵襲的な歯科治療 (IDT) は感染性内心炎 (IE) のリスクを高めません. この研究では有意な関連性が見出されず,台湾の住民はIE予防のために抗生物質の予防を必要としないことを示唆しています.
科学分野:
- 心臓病科
- 感染症
- 歯科 医学
背景:
- 侵襲的な歯科治療 (IDT) は一時的な細菌血症を引き起こし,感染症性内心炎 (IE) の危険性を懸念します.
- IDTとIEの関連性は論争の的であり,バクテリアは血流に入り,心臓組織に影響を与える可能性があります.
- この研究は,IDTとIEの関連性を明らかにすることを目的とした.
研究 の 目的:
- 侵襲的な歯科治療 (IDT) と感染性内心炎 (IE) の関連性を推定する.
- IDTがIEの発生に重大な危険因子であるかどうかを判断する.
- 歯科手術後のIE予防のための抗生物質予防に関するガイドラインを提示する.
主な方法:
- 台湾の健康保険データベースを利用して ケース専用の研究を行いました
- データを分析し,時間不変の混同因子に暗黙的に調整するために,ケースクロスオーバーと自己制御されたケースシリーズを設計した.
- 条件付きロジスティック回帰と条件付きポアソン回帰モデルを使用して,IDT後の様々な遅延でIEリスクを評価した.
主要な成果:
- 分析には9120人のIE患者 (ケース・クロスオーバー) と8181人のIE患者 (セルフ・コントロールされた症例シリーズ) が含まれていた.
- ケース・クロスオーバーでは,IDT後の4週間の内におけるIEの確率比は1. 12 (95%CI,0. 94-1.34) であった.
- IDT後1~4週間のIEの発生率比率は1. 14 (95%CI,1. 02-1.26) で,臨床的に有意なリスク増加は観察されなかった.
結論:
- IDT の後の短い期間に,臨床的に有意なIEのリスク増加は観察されなかった.
- 高リスク患者でもIDTとIEとの関連は認められなかった.
- 抗生物質によるIE予防は,これらの結果に基づいて,台湾の住民にとって必要ではないと考えられています.
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