感染性内心炎风险患者的抗生素预防:越来越多的证据基础?
Mark J Dayer1, Martin Thornhill2, Larry M Baddour3
1Consultant Cardiologist Somerset NHS Foundation Trust, Musgrove Park Hospital, Musgrove Park, Taunton, Somerset, TA1 5DA.
The British journal of cardiology
|September 14, 2023
概括
侵袭性牙科手术后,感染性内心炎 (IE) 的风险增加,特别是在高风险患者中. 抗生素预防 (AP) 显著降低了这种风险,这表明目前的指导方针可能需要更新.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 口腔健康 口腔健康
背景情况:
- 侵袭性牙科手术和传染性内心炎 (IE) 之间的联系已被争论了一个世纪.
- 缺乏潜在的随机试验导致了关于抗生素预防 (AP) 疗效的争议.
- 目前关于在侵袭性手术中使用AP的指导方针仍然不一致.
研究的目的:
- 调查侵袭性牙科手术与IE发展之间的关联.
- 评估抗生素预防 (AP) 在预防IE方面的有效性.
- 为了告知有关侵袭性手术AP的指导方针修订.
主要方法:
- 使用队列和病例交叉设计分析美国大型患者数据库.
- 检查来自英格兰的全国性住院数据.
- 审查关于侵入性手术和IE风险的现有文献.
主要成果:
- 在高风险患者中,侵入性牙科手术和IE之间发现了显著的时间关联.
- 使用抗生素预防 (AP) 与IE风险降低有关.
- 某些牙科和非牙科侵入性手术与随后的IE发展有显著联系.
结论:
- 有证据支持侵袭性牙科手术与高风险个体的IE之间存在联系.
- 抗生素预防 (AP) 在降低IE风险方面似乎有效.
- 目前的实践指南,包括NICE的指南,可能需要根据新的证据重新评估.
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