(Circulation. 2000;102:2842.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Risk Factors for Infective Endocarditis
Oral Hygiene and Nondental Exposures
From the Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics (B.L.S., E.A., J.A.B., J.L.K.) and Division of General Internal Medicine (B.L.S.), Schools of Medicine and Dental Medicine (R.S.F.), University of Pennsylvania, Philadelphia, Pa; Department of Medicine (E.A., M.E.L., O.M.K., D.K.), MCP Hahnemann School of Medicine, Philadelphia, Pa; Veterans Affairs Medical Center (R.S.F.), Philadelphia, Pa; and Department of Epidemiology and Preventive Medicine (P.D.S.), University of Maryland, Baltimore, Md.
Correspondence to Brian L. Strom, MD, MPH, Room 824 Blockley Hall, University of Pennsylvania, Philadelphia, PA 19104-6021. E-mail Bstrom{at}cceb.med.upenn.edu
Background—The risks of infective endocarditis (IE) associated with various conditions and procedures are poorly defined.
Methods and Results—This was a population-based case-control study conducted in 54 Philadelphia, Pa–area hospitals from 1988 to 1990. Community-acquired IE cases unassociated with intravenous drug use were compared with matched community residents. Subjects were interviewed for risk factors. Diagnoses were confirmed by expert review of medical record abstracts with risk factor data removed. Cases were more likely than controls to suffer from prior severe kidney disease (adjusted OR [95% CI]=16.9 [1.5 to 193], P=0.02) and diabetes mellitus (adjusted OR [95% CI]=2.7 [1.4 to 5.2], P=0.004). Cases infected with skin flora had received intravenous fluids more often (adjusted OR [95% CI]=6.7 [1.1 to 41], P=0.04) and had more often had a previous skin infection (adjusted OR [95% CI]=3.5 [0.7 to 17], P=0.11). No association was seen with pulmonary, gastrointestinal, cardiac, or genitourinary procedures or with surgery. Edentulous patients had a lower risk of IE from dental flora than patients who had teeth but did not floss. Daily flossing was associated with a borderline decreased IE risk.
Conclusions—Within the limits of the available sample size, the data showed that IE patients differ from people without IE with regard to certain important risk factors but not regarding recent procedures.
Key Words: endocarditis • heart diseases • infection
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