Background: While the relationship between recent dental treatment and the development of endocarditis is largely undisputed, the relationship between poor dental status and the development of infective endocarditis has not yet been proven beyond doubt. We have therefore analyzed this hypothetical connection using our established endocarditis register (B.E.R.). Patients and Methods: A total of 72 patients who underwent dental treatment (TREAT) and 55 patients with a desolate dental status (DESOLATE) were found in our database of 530 patients subsequently developing infective endocarditis necessitating valve surgery. A propensity score analysis was performed comparing TREAT as well as DESOLATE with matched patients without these conditions as CONTROL. Results: TREAT showed significantly more often Strept. mitis (26.9%) as well as other Streptococci (36.54%, p = 0.001) compared to CONTROL (3.51% and 10.53%, respectively), whereas Staphylococci and E. faecalis were found more often in CONTROL than in TREAT (S. aureus: 22.81% vs. 15.38%, n.s.; other Staphylococci 14.04% vs. 1.92%, p = 0.033; E. faec.: 26.32% vs. 9.62%, p = 0.045). DESOLATE showed significantly more Strept. mitis compared to CONTROL (27.91% vs. 4.88%, p = 0.007). Early mortality was 23.7% in the TREAT group, while it was 15.25% in the CONTROL group and 17.02% in the DESOLATE group vs. 20.83% in the CONTROL patients. Conclusions: The current results suggest that adequate endocarditis prophylaxis to prevent bacteremia may not be carried out in patients undergoing dental treatment and may occur spontaneously in patients with poor dental care. Both situations require new strategies to avoid such severe consequences.

Keywords: Enterococcus faecalis; Staphylococcus areus; cardiac surgery; dental care; infectious endocarditis; oral hygiene; viridans Streptococci.

背景：虽然近期牙科治疗与感染性心内膜炎的发展之间的关系基本上没有争议，但不良的口腔状况与感染性心内膜炎发展的关联尚未得到确凿证实。因此，我们使用已建立的心内膜炎登记册（B.E.R.）分析了这种假设性的联系。患者和方法：在我们的数据库中，共有530名随后需要瓣膜手术的感染性心内膜炎患者中，有72名接受了牙科治疗（TREAT），另有55名患者的口腔状况较差（DESOLATE）。对TREAT以及DESOLATE与没有这些情况的匹配对照组进行了倾向评分分析。结果：TREAT显示链球菌属米特氏链球菌（26.9%）以及其他链球菌（36.54%，p = 0.001）的比例显著高于对照组（3.51%和10.53%，分别），而金黄色葡萄球菌和其他葡萄球菌以及粪肠球菌在对照组中出现的频率更高（金黄色葡萄球菌: 22.81% vs. 15.38%，n.s.; 其他葡萄球菌：14.04% vs. 1.92%，p = 0.033; 粪肠球菌：26.32% vs. 9.62%，p = 0.045）。DESOLATE显示链球菌属米特氏链球菌的频率显著高于对照组（27.91% vs. 4.88%，p = 0.007）。TREAT组早期死亡率为23.7%，而对照组为15.25%，DESOLATE组为17.02%，与对照患者中的20.83%相比。结论：目前的结果表明，在进行牙科治疗的患者中可能没有充分执行预防心内膜炎以防止菌血症，而在口腔护理较差的患者中可能会自发发生。这两种情况都需要新的策略来避免严重的后果。

关键词： Enterococcus faecalis; Staphylococcus areus; 心脏手术; 牙科护理; 感染性心内膜炎; 口腔卫生; 肺炎链球菌