Infective endocarditis (IE) continues to cause serious morbidity and mortality. To reduce its incidence, antibiotic prophylaxis has been recommended before invasive dental procedures in patients with at risk predispositions. Several studies have examined the effect of antibiotic prophylaxis on the incidence of IE and have brought conflicting results. The investigators aim to evaluate the effectiveness of antibiotic prophylaxis before invasive dental procedures to prevent oral streptococcal infective endocarditis in patients with prosthetic heart valves and/or history of IE, using a registry-based, cluster-randomized, controlled trial. In secondary objectives, the investigators aim to analyze changes in dentists' practices.
All French Health Territories (Territoires de santé, TDS) will be included and each TDS will contribute as a cluster for randomization.
All dentists working in each TDS will be included.
Among individuals receiving an invasive dental procedure, all patients aged 18 years or more identified with prosthetic heart valves or recorded with prior infective endocarditis will be included.
No exclusion criteria for health territories, dentists and patient.
However, dental procedures that had been performed less than 6 months after the date of first implantation of prosthetic heart valve won't be included.
Parallel
Improved practices
Other interventionA package of tools including: antibiotic prophylaxis guidelines reminders, periodic reminders, the Infectious Endocarditis Prevention Card for patients at risk, practical information targeting both dentists and patients, etc…
Diagnosis of infective endocarditis
Diagnosis of infective endocarditis due to oral streptococci that occurs within 3 months after an invasive dental procedure
Antibiotic prophylaxis rate
Antibiotic prophylaxis rate in dentists according to their randomization arm (Health territories) in all patients regardless of the implantation of prosthetic heart valve and/or history of IE and their dental procedures (invasive or not). The antibiotic prophylaxis will be classified as appropriate (following the recommendation/intervention) or inappropriate
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