Oral Hygiene, Periodontal Disease, and Infective Endocarditis

口腔卫生、牙周病和感染性心内膜炎

• 批准号: 8693180
• 负责人: PETER B LOCKHART
• 金额: $ 76.63万
• 依托单位: CAROLINAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8693180
• 关键词: Address; Antibiotic Prophylaxis; Bacteremia; Bacteria; Blood; Cardiac; Cardiac Surgery procedures; Case-Control Studies; Catheters; Cessation of life; Clinical; Communities; Controlled Study; Data; Dental Care; Dental General Practice; Dental Hygiene; Development; Devices; Disease; Endocarditis; Future; Gingiva; Gingivitis; Health; Healthcare; Heart Valves; Incidence; Infective endocarditis; Knowledge; Medical; Methods; Microbial Biofilms; Morbidity - disease rate; Mouth Diseases; Odds Ratio; Oral; Oral cavity; Oral health; Patients; Periodontal Diseases; Periodontitis; Periodontium; Practice Guidelines; Prevention; Prevention Guidelines; Public Health; Research; Risk; Risk Factors; Source; Streptococcus; Testing; Tissues; Tooth structure; Work; cardiovascular risk factor; cost; design; disorder control; improved; mortality; oral bacteria; prevent; standardize measure

DESCRIPTION (provided by applicant): Infective endocarditis (IE) is a disease with a high degree of morbidity that can result in death. Healthcare- associated (HCA) IE is often due to non-oral staphylococcal bacteria and is associated with cardiac surgery, intravascular catheters, and cardiac devices. In contrast, community-acquired (CA) IE is typically due to streptococci in patients with pre-existing heart valve abnormalities. Prior studies provide some evidence that the periodontium and its biofilm may be a significant source of the bacteremia that results in CA-IE. However, no well-controlled studies have directly investigated the association of periodontal disease, periodontal bacteria, and CA-IE. Aim 1 of this multi-center case-control study is to determine if poor oral hygiene, gingivitis or periodontitis is associated with infective endocardits caused by any bacterial species. To address this aim, standardized measures of oral hygiene, gingivitis and periodontitis will be compared in 112 recently hospitalized patients with CA-IE (cases) and 224 healthy patients from the surrounding community who have cardiovascular risk factors for CA-IE but have not had the disease (controls). Aim 2 will determine if poor oral hygiene, gingivitis or periodontitis is associated with infective endocarditis caused by bacteria that ARE typically associated with poor oral hygiene or periodontal diseases. To address this aim, oral hygiene, gingivitis, and periodontitis will be compared among case patients with CA-IE who have positive blood cultures for oral bacteria that typically reside in the oral cavity and control patients from specific Aim 1. Aim 3 will determine if poor oral hygiene, gingivitis or periodontitis is associated with infective endocarditis caused by bacteria that ARE NOT typically associated with poor oral hygiene or periodontal disease. To address this aim, oral hygiene, gingivitis, and periodontitis will be compared among case patients with CA-IE who have positive blood cultures for non-oral bacteria and control patients from Specific Aim 1. If clinically and statistically significant associations are found between poor oral hygiene, gingivitis or periodontal disease and CA-IE, this study will transform our understanding of risk factors for CA-IE and will be a major step forward because it will provide supporting evidence that improving oral hygiene and maintaining periodontal health may reduce the risk for CA-IE. This has the potential to reduce the incidence of CA-IE and its associated morbidity, mortality, and cost. It would provide important information for future clinical guidelines for the prevention of endocarditis and be an important contribution to the public health in the U.S. and throughout the world for all people at risk for infective endocarditis.

描述（由申请人提供）：感染性心内膜炎（IE）是一种发病率高、可导致死亡的疾病。医疗保健相关 (HCA) IE 通常由非口腔葡萄球菌引起，并与心脏手术、血管内导管和心脏装置有关。相比之下，社区获得性 (CA) IE 通常是由既往存在心脏瓣膜异常的患者中的链球菌引起的。先前的研究提供了一些证据，表明牙周组织及其生物膜可能是导致 CA-IE 的菌血症的重要来源。然而，还没有对照良好的研究直接调查牙周病、牙周细菌和 CA-IE 之间的关系。这项多中心病例对照研究的目的 1 是确定口腔卫生不良、牙龈炎或牙周炎是否与任何细菌引起的感染性心内膜相关。为了实现这一目标，将对 112 名最近住院的 CA-IE 患者（病例）和来自周边社区的 224 名患有 CA-IE 心血管危险因素但未患过 CA-IE 的健康患者进行口腔卫生、牙龈炎和牙周炎标准化测量的比较。疾病（控制）。目标 2 将确定口腔卫生不良、牙龈炎或牙周炎是否与细菌引起的感染性心内膜炎相关，而细菌通常与口腔卫生不良或牙周病相关。为了实现这一目标，将对口腔细菌（通常存在于口腔中）血液培养呈阳性的 CA-IE 病例患者和特定目标 1 的对照患者进行口腔卫生、牙龈炎和牙周炎比较。目标 3 将确定是否口腔卫生不良、牙龈炎或牙周炎与细菌引起的感染性心内膜炎有关，而细菌通常与口腔卫生不良或牙周病无关。为了实现这一目标，将对非口腔细菌血培养呈阳性的 CA-IE 病例患者与特定目标 1 中的对照患者的口腔卫生、牙龈炎和牙周炎进行比较。如果发现较差的临床和统计学显着关联，口腔卫生、牙龈炎或牙周病和 CA-IE，这项研究将改变我们对 CA-IE 危险因素的理解，并将是向前迈出的重要一步，因为它将提供支持证据，证明改善口腔卫生和保持牙周健康可以降低风险对于 CA-IE。这有可能降低 CA-IE 的发生率及其相关的发病率、死亡率和费用。它将为未来预防心内膜炎的临床指南提供重要信息，并对美国和全世界所有有感染性心内膜炎风险的人的公共卫生做出重要贡献。