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拔牙vs不正确刷牙丨哪种方式更容易得感染性心内膜炎？

2017-12-03 SIFIC循证团队 SIFIC感染官微

感染性心内膜炎口腔侵入性操作抗菌药物
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近三十年来，只有5项相关的病例-对照研究，其中2项发现了口腔操作与链球菌性心内膜炎相关，但是没有研究发现口腔操作前预防性使用抗菌药物与链球菌性心内膜炎的关系。近期法国学者在全国范围了开展了一项大型队列及病例交叉研究，旨在进一步探究口腔侵入性操作及预防性使用抗菌药物对人工心脏瓣膜术后患者口腔链球菌性心内膜炎发病率的影响。

感染性心内膜炎（Infective Endocarditis， IE）是人工心脏瓣膜术后患者最严重的并发症之一，其感染的住院病人死亡率高达20%，五年内死亡率则更是达到了40%。基于观察性研究和动物模型，专家学者提出了“预防性使用抗菌药物”这一理念，目的是在有创性诊治操作导致短暂菌血症后预防细菌附着于心内膜。但是其有效性却一直受到质疑：目前无相关的临床随机试验或队列研究。近三十年来，只有5项相关的病例-对照研究，其中2项发现了口腔操作与链球菌性心内膜炎相关，但是没有研究发现口腔操作前预防性使用抗菌药物与链球菌性心内膜炎的关系。近期法国学者在全国范围了开展了一项大型队列及病例交叉研究，旨在进一步探究口腔侵入性操作及预防性使用抗菌药物对人工心脏瓣膜术后患者口腔链球菌性心内膜炎发病率的影响。口腔侵入性操作、抗菌药物的预防性使用与感染性心内膜炎的关系：基于人工心脏瓣膜患者的全国人群的队列与病例交叉研究口腔侵入性操作或增加IE发病率本次研究数据来源于法国医院出院管理数据库。队列研究共纳入人工心脏瓣膜术后患者138876人，其中69303（49.9%）人在术后接受过至少一次口腔诊疗。经过平均1.7

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    2018-07-02 12498974m61暂无昵称

    #内膜#

    0

  2. 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    2018-09-11 charl1234575

    #感染性#

    0

  3. 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    2017-12-08 159****9725

    学习了

    0

  4. 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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Fri Dec 08 07:08:09 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267442, encodeId=dc8626e44260, content=学习学习学习学习学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Thu Dec 07 06:58:21 CST 2017, time=2017-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267385, encodeId=79c526e385db, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160823/IMG57BBA4F88B06B5498.jpg, createdBy=29f71719637, createdName=ffffffffff, createdTime=Wed Dec 06 06:39:20 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267067, encodeId=c3fb26e067ac, content=学习学习学习学习学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Dec 05 21:25:32 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574224, encodeId=c07215e42249c, content=<a href='/topic/show?id=36fc56212c6' target=_blank style='color:#2F92EE;'>#拔牙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-08 1e131c8cm23(暂无匿称)

    学习学习学习学习再学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1708422, encodeId=51591e0842251, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Mon Jul 02 09:37:00 CST 2018, time=2018-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655397, encodeId=dc3e165539e89, content=<a href='/topic/show?id=7c2853311ac' target=_blank style='color:#2F92EE;'>#感染性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53311, encryptionId=7c2853311ac, topicName=感染性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=583d24724321, createdName=charl1234575, createdTime=Tue Sep 11 15:37:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267791, encodeId=1e0726e791ac, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/24/df6c94c647a03bde8d77b50c4fb4d531.jpg, createdBy=c84e2076847, createdName=159****9725, createdTime=Fri Dec 08 10:02:17 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267723, encodeId=15a726e723be, content=学习学习学习学习再学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160823/IMG57BBA4F88B06B5498.jpg, createdBy=29f71719637, createdName=ffffffffff, createdTime=Wed Dec 06 06:39:20 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267067, encodeId=c3fb26e067ac, content=学习学习学习学习学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Dec 05 21:25:32 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574224, encodeId=c07215e42249c, content=<a href='/topic/show?id=36fc56212c6' target=_blank style='color:#2F92EE;'>#拔牙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-07 1e131c8cm23(暂无匿称)

    学习学习学习学习学习!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1708422, encodeId=51591e0842251, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Mon Jul 02 09:37:00 CST 2018, time=2018-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655397, encodeId=dc3e165539e89, content=<a href='/topic/show?id=7c2853311ac' target=_blank style='color:#2F92EE;'>#感染性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53311, encryptionId=7c2853311ac, topicName=感染性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=583d24724321, createdName=charl1234575, createdTime=Tue Sep 11 15:37:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267791, encodeId=1e0726e791ac, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/24/df6c94c647a03bde8d77b50c4fb4d531.jpg, createdBy=c84e2076847, createdName=159****9725, createdTime=Fri Dec 08 10:02:17 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267723, encodeId=15a726e723be, content=学习学习学习学习再学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160823/IMG57BBA4F88B06B5498.jpg, createdBy=29f71719637, createdName=ffffffffff, createdTime=Wed Dec 06 06:39:20 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267067, encodeId=c3fb26e067ac, content=学习学习学习学习学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Dec 05 21:25:32 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574224, encodeId=c07215e42249c, content=<a href='/topic/show?id=36fc56212c6' target=_blank style='color:#2F92EE;'>#拔牙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-06 159****9725

    学习了

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1708422, encodeId=51591e0842251, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Mon Jul 02 09:37:00 CST 2018, time=2018-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655397, encodeId=dc3e165539e89, content=<a href='/topic/show?id=7c2853311ac' target=_blank style='color:#2F92EE;'>#感染性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53311, encryptionId=7c2853311ac, topicName=感染性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=583d24724321, createdName=charl1234575, createdTime=Tue Sep 11 15:37:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267791, encodeId=1e0726e791ac, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/24/df6c94c647a03bde8d77b50c4fb4d531.jpg, createdBy=c84e2076847, createdName=159****9725, createdTime=Fri Dec 08 10:02:17 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267723, encodeId=15a726e723be, content=学习学习学习学习再学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-06 1e131c8cm23(暂无匿称)

    学习学习学习学习!

    0

  8. 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likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-06 ffffffffff

    谢谢分享谢谢分享

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1708422, encodeId=51591e0842251, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Mon Jul 02 09:37:00 CST 2018, time=2018-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655397, encodeId=dc3e165539e89, content=<a href='/topic/show?id=7c2853311ac' target=_blank style='color:#2F92EE;'>#感染性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53311, encryptionId=7c2853311ac, topicName=感染性)], attachment=null, authenticateStatus=null, createdAvatar=null, 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160823/IMG57BBA4F88B06B5498.jpg, createdBy=29f71719637, createdName=ffffffffff, createdTime=Wed Dec 06 06:39:20 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267067, encodeId=c3fb26e067ac, content=学习学习学习学习学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Dec 05 21:25:32 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574224, encodeId=c07215e42249c, content=<a href='/topic/show?id=36fc56212c6' target=_blank style='color:#2F92EE;'>#拔牙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-05 1e131c8cm23(暂无匿称)

    学习学习学习学习学习!

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160823/IMG57BBA4F88B06B5498.jpg, createdBy=29f71719637, createdName=ffffffffff, createdTime=Wed Dec 06 06:39:20 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267067, encodeId=c3fb26e067ac, content=学习学习学习学习学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Dec 05 21:25:32 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574224, encodeId=c07215e42249c, content=<a href='/topic/show?id=36fc56212c6' target=_blank style='color:#2F92EE;'>#拔牙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56212, encryptionId=36fc56212c6, topicName=拔牙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9c5216012416, createdName=xre2013, createdTime=Tue Dec 05 14:37:00 CST 2017, time=2017-12-05, status=1, ipAttribution=)]
    2017-12-05 xre2013

    #拔牙#

    0

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