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The epidemiological and clinical features of odontogenic infective endocarditis


Antibiotic prophylaxis (AP) of infective endocarditis (IE) in dental practice is a controversial topic. We evaluated the characteristics of the odontogenic IE and assessed the practice and sources of information pertaining to the topic utilized by the Croatian dentists. We conducted a retrospective review of consecutive medical charts of adult patients with IE, admitted to the University Hospital for Infectious Diseases in Zagreb, Croatia, between January 2007 and December 2017. In addition, a cross-sectional, self-reporting questionnaire survey was conducted with participation of 348 Croatian dentists. Of the 811 admissions for suspected IE (40.3% of all Croatian and 92.1% of all Zagreb hospitals), 386 patients were confirmed as definite IE: 68 with odontogenic IE and 318 with IE of other origin. Their first hospital admissions were analyzed. Definite odontogenic IE was defined as a positive echocardiographic result in conjunction with two separate positive blood cultures showing exclusive oral cavity pathogen or Streptococcus viridans associated with current or recent (< 1 month) dental, periodontal, or oral cavity infection. The annual number of new odontogenic IE patients appeared constant over time. In 91.2% of the cases, odontogenic IE was not preceded by a dental procedure; poor oral health was found in 51.5% of patients, and 47.1% had no cardiac condition that increases the IE risk. In-hospital mortality was 5.1% with conservative treatment and 4.5% with cardiac surgery and was much lower for odontogenic IE than in non-odontogenic IE (14.6% and 34.4%, respectively). An increasing number of admissions for non-odontogenic IE were observed in parallel with an increasing number of staphylococcal IE. Surveyed dentists (500 invited, 69.6% responded) were aware of the AP recommendations, but were largely reluctant to treat patients at risk. In people with poor oral health, AP should be considered regardless of cardiac risk factors. Improvement of oral health should be the cornerstone of odontogenic IE prevention.

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Authors and Affiliations



Ivana Šutej and Dragan Lepur were primarily responsible for data collection and the study conception and design. Material preparation and analysis were performed by Ivana Šutej, Vladimir Trkulja, and Dragan Lepur. The first draft of the manuscript was written by Ivana Šutej, Kristina Peroš, and Dragan Lepur, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Dragan Lepur.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committees of the School of Dental Medicine, University of Zagreb, (approval no. 05-PA-30-IV-2/2019) and the University Hospital for Infectious Diseases “Dr Fran Mihaljević”, Zagreb, Croatia (approval No. 01–397–2-2019). All procedures were conducted in accordance with the recommendations of the Declaration of Helsinki.

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Not applicable in the present study.

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Šutej, I., Peroš, K., Trkulja, V. et al. The epidemiological and clinical features of odontogenic infective endocarditis. Eur J Clin Microbiol Infect Dis 39, 637–645 (2020).

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  • Infective endocarditis
  • Odontogenic
  • Antibiotic
  • Prophylaxis