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Relevance. Infective endocarditis (IE) is a rare but devastating condition in which the innermost lining of the heart becomes infected. This may include more than one valve, which can lead to severe valvular failure and heart failure. It can also progress to abscess formation, septic embolism, stroke, and organ ischemia [1].
Knowledge, current practice, and inconsistency in pre-procedure antibiotic prophylaxis against infective endocarditis for patients with various cardiac lesions is a prerequisite for the development of infective endocarditis.

Aim. Conduct a literature review of scientific studies studying the incidence of infective endocarditis in order to substantiate the relationship between infective endocarditis and odontogenic infection.
Materials and methods. A systematic review was conducted in the PubMed electronic database with a depth of 5 years from 2018 to 2022.

Results. The aim of the study was to investigate the relationship between infective endocarditis and odontogenic infection. As a result of a systematic review, most studies on the etiology of infective endocarditis indicate Staphylococcus aureus as the main causative agent of IE. In second place in terms of frequency of the pathogen is the group Streptococcus viridans, as a result of which a connection between infective endocarditis and odontogenic infection is assumed, since the incidence of this group of streptococci is characteristic of odontogenic infection.

Findings. The data obtained during the study related to the research topics indicate that a more in-depth and evidence-based study of the type of RCT is needed due to the incompleteness of the available data. Therefore, it is impossible to completely refute the relationship between infective endocarditis and odontogenic infection according to the available data, as well as its absolute confirmation.

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Relevance. Infectious endocarditis (IE) is a lesion of the endocardium of an infectious nature caused by bacteria, fungi or other infectious agents. It can be classified according to its course (acute or subacute/chronic), the valve involved (native or prosthetic), the number of affected valves, the method of its acquisition (community, intravenous drug addicts or related to healthcare) and the microorganism involved [2, 3].
IE is considered a rare disease, but a very serious disease with high mortality rates. The incidence of IE is 3-7/100,000 people, and mortality in the hospital ranges from 15 to 30% [4]. According to Thoresen T P et al 2022, the mortality of IE during 5 and 10 years is 29% and 56.8% [5].
The main infectious agents were considered to be microorganisms of the streptococcus family of the viridans group, but the last decade of research indicates the change of the causal microorganism to the genus of staphylococci of the aureus species. One such study is the work of Nappi F et al 2022, where they indicate that the prevalence of S. aureus is 26.6% whereas Oral Streptococcus is 18.7% [6].
Also, one of the main changes is the frequency of occurrence of IE in the elderly. Since in the early 1980s, IE developed more often in people about 40 years old, the current situation shows that the prevalence of IE is more common in older people aged 65 to 70 years [7]. This trend is explained by the fact that the survival rate of cardiac surgery patients has greatly increased in recent years, as well as children who have undergone heart surgery for congenital heart disease.
Rheumatic valve diseases and congenital heart defects were the main risk factors in the past, but the indicators are decreasing, degenerative valve disease is now the main disease. Patients, as a rule, are older and with multiple concomitant diseases
of the target. To conduct a literary review of scientific studies studying the incidence of infectious endocarditis in order to substantiate the connection between infectious endocarditis and odontogenic infection.
Materials and methods. A systematic review of scientific articles in the PubMed electronic database was carried out with a depth of 5 years from 2018 to 2022.. Keywords that were searched for: infectious endocarditis (IE), dentistry, oral health. Exclusion criteria: case reports, editorials, abstracts, animal studies, non-full-text articles. Inclusion criteria: open access articles, international recommendations on infectious endocarditis from ESC (European Cardiological Association) /AHA (American Cardiological Association). A total of 65 articles were found, after applying filters and excluding articles not related to the research topic according to the criteria. 10 articles were included in this work, including articles on systematic review (1) and meta-analysis (1), observational (3), review (5).
Results. In recent years, the epidemiology of endocarditis has changed both with respect to pathogens and host, and the spectrum of bacteria. While Streptococcus viridans was the most common microbe in the past, Staphylococcus aureus has been gaining strength recently. 80-90% of infectious endocarditis is caused by gram-positive cocci of Staphylococcus, streptococcus and enterococcus species.S aureus is the cause in high-income countries, causing up to 30% of infections. In low-income countries, the causative bacteria leading to infectious endocarditis are streptococci (Gram-positive cocci of Streptococcus include Streptococcus mutans, Streptococcus salivarius, Streptococcus anginosus, Streptococcus mitis and Streptococcus sanguinis, which are isolated as commensals of oral, gastrointestinal and genitourinary tract), of which the oral viridans group is retained as the most common an excitatory microbe. Infections associated with the development of enterococcal foci occur in 10% of people. The type of isolated microbe is mainly Enterococcus faecalis, which is the cause of both native and prosthetic valve endocarditis that occurs in elderly and seriously ill patients. Cases of IE supported by Enterococcus faecium have been reported, which leads to increased resistance to vancomycin, aminoglycosides and ampicillin [6, 8].
In 1909, Thomas Horder recognized that the oral cavity is the main portal for the penetration of bacteria, and in 1935, after tooth extraction, a streptococcal bacterium was discovered [9].
The main determining variable of the relationship between infectious endocarditis and odontogenic infection is Streptococcus viridans, but the identification of this microorganism and other representatives is difficult. A positive blood culture is the main diagnostic criterion for infectious endocarditis, but identification of the etiology may fail due to several factors: pre-administration of antibiotics before culture, fastidious or difficult-to-cultivate infectious organisms such as HACEK or fungi, or poor microbiological techniques during collection and cultures.
The first trials of penicillin prevention were conducted in the 1940s and showed that antibiotics reduce the incidence of bacteremia after tooth extraction. In 1955, the American Heart Association (AHA) published guidelines recommending antibiotic prevention for patients with rheumatic heart disease. Maintaining good oral hygiene and prevention of antibiotics for at-risk groups undergoing tooth extraction has become the standard of treatment for 50 years. Between 2007 and 2009, guidelines in the United States and Europe were substantially revised to limit the use of antibiotic prevention. There were several reasons for these changes. Firstly, in the era of evidence-based practice, there were (and still are) randomized controlled trials (RCTs) of antibiotic prophylaxis for the prevention of infectious endocarditis in the context of tooth extraction. Secondly, the effectiveness of prevention has been questioned based on an apparent failure rate of up to 50%. Thirdly, the importance of the widespread use of antibiotics as a means of introducing new resistance is being recognized, while indications for prevention have expanded significantly to cover groups with moderate risk. Finally, the importance of dental procedures as a cause of IE has been questioned due to demographic studies that have not shown that dental intervention is a major risk factor. On the contrary, "everyday" bacteremia due to brushing teeth, chewing and insufficient dental hygiene was recognized as a possible cause of IE. In the cohort awaiting tooth extraction (i.e. for dental diseases), one tooth brushing was enough to cause bacteremia in 23%. The relative importance of rare and high-frequency bacteremia (for example, caused by tooth extraction) compared to general low-level bacteremia in the pathogenesis of IE remained poorly defined. Thus, in the United States and Europe, antibiotic prevention has been limited to those most at risk. Meanwhile, in the United Kingdom, the National Institute of Excellence in Health and Care (NICE) in 2008, the prevention of antibiotics was completely abandoned in an extremely controversial decision of the UK [10].
Discussion. The main problem of infectious endocarditis is the discrepancy between the trends towards early diagnosis and surgical intervention in terms of mortality for 1 year, which has not improved for more than 2 decades. This indicates that infectious endocarditis persists as a major problem, despite its change in representation from the era of preantibiotics, to the first generations of targeted antibiotic treatment and, finally, for the current population of patients who have all undergone changes in the profile of microbiology.
Thus, at the moment there are no RCTs for the presence of a connection between IE and odontogenic infection, in the recommendations for IE from ESC/AHA, the mandatory use of antibiotics in patients at high risk of developing IE accompanied by a dental invasive procedure is included in the prevention list. NICE issued guidelines for the prevention of IE in 2008, where it completely excluded the use of antibiotics for patients undergoing dental intervention, but two studies in England in 2011 and 2017 showed that the complete rejection of antibiotic prevention led to an increase in IE patients.
Conclusion. Prevention of IE is better than treatment, and requires an understanding of the mechanisms of the disease, groups of patients at risk, and effective preventive intervention. Assessment of the spectrum of pathogens causing bacterial endocarditis in the community and the prevalence of pathogens in relation to various categories of patients can help in the initial treatment of patients, which is empirical before the identification of an etiological agent or in patients with culturally negative endocarditis. Gaps in the availability of evidence , it is impossible to confirm this connection or . The guiding principles from the European and American Societies preserve the prevention of IE development during invasive dental procedures, therefore it is impossible to completely refute the connection between infectious endocarditis and odontogenic infection and requires further study in RCT conditions.


About the authors

Zhumakyz Daniyalovna Kussainova

SMU, NCJSC (Semey Medical University, Non-Commercial Joint-Stock Company)

ORCID iD: 0000-0002-5356-0461
SPIN-code: 4106-1798

Master of Medical Sciences, Assistant of the Department of Dental Disciplines and Maxillofacial Surgery

Kazakhstan, 071400, Abay region, Semey, st. Abay, 103

Tolkyn Alpysbayevich Bulegenov

SMU, NCJSC (Semey Medical University, Non-Commercial Joint-Stock Company)

ORCID iD: 0000-0001-6145-9649
Kazakhstan, 071400, Abay region, Semey, st. Abay, 103

Sholpan Shagataevna ABRALINA

SMU, NCJSC (Semey Medical University, Non-Commercial Joint-Stock Company)

Author for correspondence.
ORCID iD: 0009-0005-1555-1993
Kazakhstan, 071400, Abay region, Semey, st. Abay, 103

Askar Muratovich ABILTAEV

Pavlodar Regional Cardiology Center

ORCID iD: 0000-0003-4127-2347
Kazakhstan, 3, Tkacheva st. 10, Pavlodar 140000

Merkhat Rymtaevich Nasymbekov

Semey Emergency Hospital

ORCID iD: 0009-0009-4007-4059
Kazakhstan, Michurina street 140A, Semey 071404

Dana Mukashevna Suleimenova

SMU, NCJSC (Semey Medical University, Non-Commercial Joint-Stock Company)

ORCID iD: 0000-0002-8943-3384
Kazakhstan, 071400, Abay region, Semey, st. Abay, 103


  1. Federspiel JJ, Stearns SC, Peppercorn AF, Chu VH, Fowler VG Jr. Increasing US rates of endocarditis with Staphylococcus aureus: 1999-2008. Arch Intern Med. 2012 Feb 27;172(4):363-5. doi: 10.1001/archinternmed.2011.1027. PMID: 22371926; PMCID: PMC3314241.
  2. Christine Selton-Suty, Marie Célard, Vincent Le Moing, Thanh Doco-Lecompte, Catherine Chirouze, Bernard Iung, Christophe Strady, Matthieu Revest, François Vandenesch, Anne Bouvet, François Delahaye, François Alla, Xavier Duval, Bruno Hoen, on behalf of the AEPEI Study Groupa, Preeminence of Staphylococcus aureus in Infective Endocarditis: A 1-Year Population-Based Survey, Clinical Infectious Diseases, Volume 54, Issue 9, 1 May 2012, Pages 1230–1239,
  3. Šutej I, Par M, Lepur D, Peroš K, Pintarić H, Alajbeg I, Vuger L. Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis- National survey study. J Clin Exp Dent. 2021 Jul 1;13(7):e648-e652. doi: 10.4317/jced.58054. PMID: 34306527; PMCID: PMC8291157.
  4. Apolinário P, Campos I, Oliveira C, Silva C, Arantes C, Martins J, Salgado A, Salomé N, Rodrigues C, Medeiros P, Bizarro Pinho J, Marques J, Vieira C. Infective endocarditis: Epidemiology and prognosis. Rev Port Cardiol. 2022 Apr;41(4):283-294. English, Portuguese. doi: 10.1016/j.repc.2021.02.027. Epub 2022 Mar 22. PMID: 36062660.
  5. Thoresen T, Jordal S, Lie SA, Wünsche F, Jacobsen MR, Lund B. Infective endocarditis: association between origin of causing bacteria and findings during oral infection screening. BMC Oral Health. 2022 Nov 15;22(1):491. doi: 10.1186/s12903-022-02509-3. PMID: 36376875; PMCID: PMC9664784.
  6. Nappi F, Martuscelli G, Bellomo F, Avtaar Singh SS, Moon MR. Infective Endocarditis in High-Income Countries. Metabolites. 2022 Jul 25;12(8):682. doi: 10.3390/metabo12080682. PMID: 35893249; PMCID: PMC9329978.
  7. Tong HJ, Hu S, Mok BY, Islam I, Hong CH. Antibiotic prophylaxis prescribing practices of dentists in Singapore. Int Dent J. 2014 Apr;64(2):108-14. doi: 10.1111/idj.12088. Epub 2014 Jan 11. PMID: 24410003; PMCID: PMC9376419.
  8. Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet. 2015 Mar 28;385(9974):1219-28. doi: 10.1016/S0140-6736(14)62007-9. Epub 2014 Nov 18. PMID: 25467569; PMCID: PMC5599216.
  9. Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, Schäfers HJ, Prendergast BD. Challenges in Infective Endocarditis. J Am Coll Cardiol. 2017 Jan 24;69(3):325-344. doi: 10.1016/j.jacc.2016.10.066. PMID: 28104075.
  10. Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, Mehta JL. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015 May 19;65(19):2070-6. doi: 10.1016/j.jacc.2015.03.518. PMID: 25975469.

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