Risk factors for infective endocarditis - Oral hygiene and nondental exposures

Background-The risks of infective endocarditis (IE) associated with various conditions and procedures are poorly defined. Methods and Results-This was a population-based case-control study conducte d in 54 Philadelphia, Pa-area hospitals from 1988 to 1990. Community-acquir ed IE cases unassociated with intravenous drug use were: compared with matc hed community residents. Subjects were interviewed for risk factors. Diagno ses were confirmed by expert review of medical record abstracts with risk f actor data removed. Cases were more likely than controls to suffer from pri or severe kidney disease (adjusted OR [95% CI]=16.9 [1.5 to 193], P=0.02) a nd diabetes mellitus (adjusted OR [95% CI]=2.7 [1.4 to 5.2], P=0.004). Case s infected with skin flora had received intravenous fluids more often (adju sted OR [95% CI]=6.7 [1.1 to 41], P=0.04) and had more often had a previous skin infection (adjusted OR [95% CI]=3.5 [0.7 to 17], P=0.11). No associat ion was seen with pulmonary, gastrointestinal, cardiac, or genitourinary pr ocedures or with surgery. Edentulous patients had a lower risk of IE from d ental flora than patients who had teeth but did not floss. Daily flossing w as associated with a borderline decreased IE risk. Conclusions-Within the limits of the available sample size, the data showed that IE patients differ from people without IE with regard to certain impo rtant risk factors but not regarding recent procedures.