Antibiotic prophylaxis against infective endocarditis in adult and child patients

نم ةياقولا لوح نانسلأا ءابطأ ةفرعم ىدم مييقت :فادهلأا ،ةيدوعسلا ةيبرعلا ةكلملما يف يبلقلا فاغشلا باهتلا ىودع ماعل ةيكيرملأا بلقلا ةيعمج نم ةيهيجوتلا ئدابلما عابتاو .م2007 سرام رهش للاخ ةيعطقلما ةساردلا هذه تيرجأُ :ةقيرطلا مهلمع نوسرايم نيذلا نانسلأا ءابطأ نم 801 تلمشو ،م2014 نم ةفلتخم قطانم يف صالخاو ييمداكلأاو يموكلحا عاطقلا يف نأشب نايبتسا ءلبم نوكراشلما ماق دقل .ةيدوعسلا ةيبرعلا ةكلملما باهتلا نم ةياقولل ةيويلحا تاداضلما مادختسلا ةجالحا :نم لًاك يئاقولا جلاعلاو ،نانسلأاو بلقلا ضارمأو ،يبلقلا فاغشلا ىضرلما عم اهب ىصولما تاءارجلإا نع لًاضف ،لافطلأاو ينغلابلل كلذكو ،ةنمزلما تلااحلل ةيويلحا تاداضلما نومدختسي نيذلا ليلتح تمو .نانسلأا بط يف ةئراطلا تلاالحا عم يئاقولا جلاعلا رابتخا و دحاو هاتجاب نيابتلا رابتخا مادختساب اًيئاصحإ تامولعلما .)p<0.05( ةيئاصحلإا ةللادلا ىوتسم دنع كلذو يت ةيلامجلإا ةفرعلما ىوتسم نأب ةساردلا جئاتن تراشأ :جئاتنلا دق ينكراشلما عيملج ةيويلحا تاداضلما مادختساب ةياقولا نأشب ماع دعبو لبق ينجيرلخا ينب ريبك قرف دوجو عم 52.2% تناك ةحارج و جلاع ينيئاصخأو ينحارلجا نم لًاك لجس دقو .م2007 بط تاصصخت عم ةنراقلماب كلذو ةفرعلما تايوتسم ىلعأ ةثللا ىدل لضفلما ءاودلا ينليسيسكوملأا ناك امك .ىرخلأا نانسلأا .ةساردلا يف ينكراشلما نم 63.9% ينمضتو رمتسلما ميلعتلا ةرورض ةساردلا هذه ترهظأ :ةتمالخا ةفاضلإاب ،بلاطلل ةيساردلا جهانلما يف اًيمسر ةيهيجوتلا ئدابلما تادايع ءاحنأ عيمج يف ةيجيتارتسا عقاوم يف اهعضو ىلإ .نانسلأا Objectives: To evaluate dentists’ knowledge regarding the prevention of infective endocarditis in Saudi Arabia and their implementation of the 2007 American Heart Association guidelines. Methods: In this cross-sectional study, in March 2014, 801 dentists who practice in different regions of Saudi Arabia completed a questionnaire regarding the need for antibiotic prophylaxis for specific cardiac conditions and specific dental procedures, prophylaxis regimens in adults and children, and recommendations for patients on chronic antibiotics, and in dental emergencies. The data were analyzed using one-way analyses of variance )ANOVAs( and independent t-tests, and a p-value <0.05 was considered statistically significant. Results: The total knowledge level regarding antibiotic prophylaxis among all participants was 52.2%, with a significant difference between dentists who graduated before and after 2007. Comparing the level of knowledge among different dental specialists, surgeons and periodontists had the highest level of knowledge regarding the use of antibiotic prophylaxis. Amoxicillin was prescribed as the drug of choice by 63.9% of the participants. Conclusion: This study emphasized the need for continuous education and for formal inclusion of the guidelines in the students’ curriculum, as well as for strategic placement of the guidelines in locations throughout dental clinics. Saudi Med J 2015; Vol. 36 (5): 554-561 doi: 10.15537/smj.2015.5.10738 From the Department of Prosthodontics (Al-Fouzan), College of Dentistry, King Saud University, the Department of Pediatrics (Al-Balawi), Children’s Hospital, King Fahad Medical City, Riyadh, and the Department of Prosthodontics (Al-Shinaiber, Al-Baijan), Prince Salman University, Al-Kharj, Kingdom of Saudi Arabia. Received 11th November 2014. Accepted 19th February 2015. Address correspondence and reprint request to: Dr. Afnan F. Al-Fouzan, Department of Prosthodontics, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Kingdom of Saudi Arabia. E-mail: [email protected] OPEN ACCESS 554 Saudi Med J 2015; Vol. 36 )5( www.smj.org.sa 555 www.smj.org.sa Saudi Med J 2015; Vol. 36 )5( Infective endocarditis prophylaxis ... Al-Fouzan et al I endocarditis )IE( is a rare, potentially life-threatening infection of the heart valves or endocardium, and it is often found in association with congenital or acquired cardiac defects. Despite advances in IE diagnosis, antimicrobial therapy, surgical techniques, and the management of complications, high morbidity and mortality rates continue to be associated with this infection.1 The basic pathology of IE involves turbulent blood flow produced by certain types of congenital or acquired heart disease that can traumatize the endothelium, resulting in the deposition of platelets and fibrin on the damaged endocardium or endothelial surface.2 This deposition can result in the formation of sterile vegetation, a condition known as nonbacterial thrombotic endocarditis.2 Invasion of the bloodstream by microbes that can colonize these damaged sites can result in IE.1 The focus of infection is determined by the ability of various microbial species to adhere to specific anatomical sites.3 Once attached to an anatomical focus, these microorganisms stimulate further deposition of fibrin and platelets on their surfaces. After they are buried, the microorganisms can multiply rapidly, apparently uninhibited by host defenses.3 Manipulation of the teeth and periodontal tissues leads to bacteremia. Different dental procedures have been associated with a broad variation in the frequency, duration, and magnitude of bacteremia.3 For this reason, many published studies have focused on prevention or on decreasing the magnitude and/ or duration of bacteremia using antimicrobial agents. Amoxicillin has had a significant impact on reducing the incidence, nature, and duration of bacteremia caused by dental procedures, but it does not eliminate the bacteremia.4-6 The data from Saudi Arabia on the epidemiology of IE is lacking due to the absence of nationwide epidemiological studies. In a review of more than 10 years of data, Nashmi and Memish7 reported that rheumatic heart disease remained the most common valvular heart disease in Saudi Arabia. In a study performed in 2006 that assessed the practice of antibiotic prophylaxis for bacterial endocarditis among Riyadh dentists,8 the findings showed that 96.9% of respondents were using prophylactic antibiotics in patients susceptible to IE. The American Heart Association )AHA( has regularly reviewed and revised its guidelines for the prevention of IE since 1955, and the most recent guidelines were published in 2007.3,9-16 There has been a paucity of information in published studies regarding dentists’ knowledge of IE prevention in Saudi Arabia. Therefore, the aim of this study was to evaluate the knowledge of dentists regarding the prevention of IE in Saudi Arabia and the implementation of the 2007 AHA guidelines. Methods. In this cross-sectional study, in March 2014, a 4-page questionnaire was emailed to members of the Saudi Dental Society whose contact information was in the Society’s database, together with an explanatory letter requesting participation and ensuring anonymity. The inclusion criteria for this study included being a dentist who was a member of the Saudi Dental Society and who practiced dentistry in Saudi Arabia. The questionnaire was pretested and evaluated by 10 dentists )King Saud University faculty(; additionally, it was evaluated by a cardiologist. After obtaining all of the comments, appropriate modifications were made. The questionnaire )a modification of the questionnaire created by Zadik et al17( asked questions in 4 major areas. The first part gathered demographic data, including gender, age, nationality, graduation place, year of graduation )bachelor degree(, workplace, working region, position at work, and dental specialty )if any(, and it asked regarding the sources of knowledge on IE prevention. The second part consisted of the following 12 cardiac conditions and asked whether they require prophylactic antibiotics according to the current AHA guidelines: prosthetic cardiac valves, patent ductus arteriosus, physiological heart murmur, mitral valve prolapse )MVP( with and without valvular regurgitation, myocardial infarction in the last 6 months, previous coronary bypass graft surgery, hypertrophic cardiomyopathy, intravascular cardiac pacemaker, previous IE, past heart transplant due to cardiomyopathy, and unrepaired cyanotic congenital heart disease. The third part consisted of the following 11 different dental procedures and asked whether they required prophylactic antibiotics according to the current AHA guidelines: scaling, restoration of class II caries lesions, endodontic treatment )beyond the apex(, periodontal surgery, intraoral radiographic tooth extraction, shedding of primary teeth, local anesthesia )infiltration(, placement of a retraction cord, placement of an orthodontic appliance )bands(, and tooth preparation when obtaining an oral impression. The fourth part focused on prophylactic regimens for allergic and non-allergic patients and the actions recommended for patients who require prophylactic antibiotics in Disclosure. Authors have no conflict of interests, and the work was not supported or funded by any drug company.