Outbreak of bacterial endocarditis associated with an oral surgery practice

Abstract

Infection prevention training should be emphasized at all levels of professional dental training. All dental health care personnel establishing intravenous treatment and administering intravenous medications should be trained in safe injection practices.

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 1

“…Here, based on recent and current knowledge, we focus on two well-known bacterial strains, S. aureus and Enterococcus, and their resistant strains. It is known that S. aureus and Enterococcus faecalis have been implicated in implant-associated infections [21,23,24,81], endodontic infections [22,25,82], and recently in an outbreak of Enterococcus endocarditis [11]. We focus on these Gram-positive bacteria for the high innate resistance or ability to become resistant to most antibiotics along with some other virulence factors (hydrophobicity, adherence to abiotic surfaces (including dental implant materials), biofilm formation, ability to growth also in anaerobic conditions) [83].…”

“…caries, endodontic infections, periodontitis) and peri-implant infective disease, and its strains are peculiar in comparison to food ones [120]. Recently, public health officials reported an incidence rate of enterococcal endocarditis among the total patient population at the oral surgery practice, more than 200 times the expected rate among general population [11].…”

“…Nowadays, Enterobacteriaceae and some resistant strains are present in oral cavity of dental patients, and recently, the transmission in dental practice has been proven [11,[120][121][122][123][124]. For dentistry of the future, whole-genome sequencing seems promising to study Enterobacteriaceae antimicrobial resistance based on genotype alone [125] and the role in dental implant-associated infections.…”

“…About 4-17% of AEs are due to infection [4,5]. The iatrogenic infectious risk in dentistry has not been quantify closely yet [6,7], but recently, some outbreaks caused by infective agents, mainly blood-borne viruses and water-borne bacteria, have been documented in dental settings based on molecular biological assays and/or retrospective investigations [8][9][10][11].…”

“…Here, we think it is important to update these conclusions in the light of the global, wide, and long-term abuse and misuse of antibiotics in dentistry and selective pressure on opportunistic bacteria by favoring potentially pathogenic strains [16,17]. In addition, the limited awareness on infection prevention guidelines and lapses and errors during infection prevention according to Centers for Disease Control and Prevention (CDC) dental guidelines [6,[8][9][10][11] sustain the evidence of possible reservoirs of ARIAs in humans (patient, dental staff) and in the environment (clinical contact surfaces (CCSs), dental instruments, and dental unit water lines (DUWLs)) and possible hazards in surgical dental setting. Our approach is in line with the CDC recommendation, in which it states that "Preventing infections negates the need for antibiotic use in the first place, and scientific evidence shows that reducing antibiotic use in a single facility can reduce resistance in that facility" [18][19][20].…”