We thank Prof. Lübbecke for his comment on our article. The high risk group in whom antibiotic prophylaxis is indicated includes—among others—patients with a history of infective endocarditis as well as patients with artificial valves (surgical as well as interventionally implanted). In these patients, prophylactic antibiotics are recommended in a scenario of high-risk procedures—such as dental procedures that lead to bacteremia (1).
Such high-risk procedures include interventions with manipulation of the gingiva, the periapical dental region, or with perforation of the oral mucosa (1). Accordingly, professional dental hygiene treatments are included in these. The mentioned examples of patients with prosthetic heart valve endocarditis after professional dental hygiene treatments indicates that in routine clinical practice, in high-risk patients with prosthetic heart valves, probably no or insufficient prophylactic antibiotics are administered—contrary to the recommendation. In high-risk patients and patients with prosthetic valves, the recommendation is for antibiotic prophylaxis in procedures that entail manipulation of the gingiva—as is the case for dental hygiene treatments.
A recently published systematic review and meta-analysis by Lean et al. (2) indicates an association between dental procedures and infective endocarditis. The article supports the guideline recommendations for administering antibiotic prophylaxis in high-risk patients for dental procedures in order to prevent infective endocarditis (2).
For other indications, the evidence (randomized controlled trials, RCTs) to date has not been convincing enough to confirm any association between bacteremia after a non-dental procedure and the risk of subsequent infective endocarditis (1, 3). According to observational studies, however, invasive procedures—such as cardiovascular interventions, skin and wound treatments, transfusions, and dialysis were associated with an increased risk for infective endocarditis. For this reason, an aseptic working environment should be ensured in order to minimize the risk of infective endocarditis (1).
Footnotes
Conflict of interest statement
NJ has received payment for the preparation of manuscripts for Bayer, Gilead, Infectopharm, Medacta, and MSD. She has received reimbursement of travel expenses from Basilea, Correvio, Gilead, Novartis, and Pfizer.
CW declares that she has no conflict of interest.
References
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