Endocarditis Prophylaxis

To the Editor—The work by Duval and colleagues [1] is interesting because it shows that patients' oral health and dental hygiene play an important role in the etiology of streptococcal endocarditis. It is also likely that the continuous improvement of the dental condition of modern populations explains the very significant decrease of endocarditis with streptococci of buccal origin [2]. However, the careful reanalysis of their data does not support the conclusion that antibiotic prophylaxis before dental care plays a role, which is currently the most debated subject [3]. In fact, the analysis of their data, obtained from supplementary material online, makes it possible to confirm or not whether antibiotic prophylaxis could prevent streptococcal endocarditis in a patient with underlying valvulopathy. Indeed, among the 12 patients with oral streptococcal endocarditis, 3 had no known valvulopathy, and the one who had known valvulopathy received antibiotic prophylaxis. These 4 are outside the purpose of this study. Therefore, only 8 patients among a cohort of 73 patients with oral streptococcal endocarditis could be analyzed vs 11 patients with endocarditis due to another microorganism in a cohort of 192 patients. This difference is not significant. Following this analysis, this work confirms that there is no evidence in the literature showing an even slight effect of prophylaxis of oral streptococcal endocarditis by the use of antibiotic prophylaxis before dental care.

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