ANTIBIOTIC PREVENTION DURING DENTAL INTERVENTIONS AND THE RISK OF INFECTIOUS ENDOCARDITIS IN HIGH-RISK GROUPS ANALYSIS OF THE NATIONAL REGISTRY

The aim of the study was to evaluate the relationship between the appointment of antibiotic prophylaxis for invasive dental procedures and the risk of developing infectious endocarditis in patients at high cardiac risk based on a model analysis of data from the national registry and clinical material from the Novosibirsk dental clinic. The model national registry included data from patients with confirmed infectious endocarditis over the age of eighteen who were hospitalized in cardiological hospitals in the country over a five-year period. The cases in which invasive dental intervention was performed within four weeks before the manifestation of the disease were analyzed. Patients with serious structural heart damage and other high-risk conditions were allocated to a separate group. Additionally, a study was conducted at the Novosibirsk dental clinic, which consistently included fifty high-risk patients who needed invasive dental interventions. The incidence of infectious endocarditis during a twelve-month follow-up period was assessed, depending on the fact of antibiotic prophylaxis according to current recommendations. According to the model registry, approximately one sixth of patients with infectious endocarditis had a temporary association with previous dental procedures, while the majority had serious cardiac diseases and only a minority received preventive antibiotics. In the clinical group of Novosibirsk, the development of infectious endocarditis was registered in three patients during the year, and the frequency of the event was lower among those who received antibiotic prophylaxis. Based on the combined data, a systematic prevention scheme is proposed that combines risk stratification, an assessment of the nature of dental intervention, the choice of an antibacterial drug, and organizational measures aimed at increasing the adherence of both cardiologists and dentists to current recommendations. The results emphasize the need for an integrated approach in which antibacterial prophylaxis is strictly addressed to patients at the highest risk, and the leading role in preventing infectious endocarditis is given to maintaining dental health, early rehabilitation of infection foci and interdisciplinary interaction.

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