Antibiotic Prophylaxis During Invasive Dental Procedures in Patients With Prosthetic Heart Valves ― Cross-Sectional Analysis of Japanese Claims Data ―

Q: What are the key findings of this study?

Antibiotic prophylaxis was prescribed in only 9.2% of 52,247 invasive dental procedures among patients with prosthetic heart valves, with dental clinics overusing Watch antibiotics (OR 9.0, P<0.01).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Prosthetic heart valves undergoing invasive dental procedures (n=3664). Intervention: Invasive dental procedures. Primary outcome: Antibiotic prophylaxis prescription rate across invasive dental procedures.

Q: What does this research mean for the field?

Antibiotic prophylaxis is substantially underused during invasive dental procedures in patients with prosthetic heart valves (prescribed in only 9.2% of procedures), with dental clinics significantly overprescribing broad-spectrum Watch group antibiotics compared to hospitals. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chie Yamamoto; Mami Ishida; Hiroshi Ikai; Fumishige Oseko; Yuta Nakagawa; Tetsuhiro Yamano; Tohru Inaba; Daisuke Matsui; Naoyuki Takashima; Yoko Nukui

doi:10.1253/circj.cj-26-0476

October 30, 2026Circulation JournalOpen Access

Antibiotic Prophylaxis During Invasive Dental Procedures in Patients With Prosthetic Heart Valves ― Cross-Sectional Analysis of Japanese Claims Data ―

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Key result

Antibiotic prophylaxis occurs in only ~9% of invasive dental procedures for prosthetic valve patients.

n=3,664

Why the study?

Although antibiotic prophylaxis is recommended during invasive dental procedures for patients with prosthetic heart valves, data on routine procedures and prescribing quality remain limited.

Key Points

To investigate real-world antibiotic prophylaxis practices across various invasive dental procedures and evaluate prescribing quality in patients with prosthetic heart valves.
Cross-sectional analysis of Japanese claims data evaluating 52,247 invasive dental procedures (IDPs) across 3,664 patients with prosthetic heart valves (PHVs).
Antibiotic prophylaxis (AP) was defined as oral or intravenous antibiotics prescribed within 7 days before or on the day of the procedure, with drug selection assessed via the WHO AWaRe classification.
The overall AP prescription rate across all IDPs was 9.2% (4,786/52,247), with highest rates for tooth extraction (47.3% [1,533/3,239]) and lowest for scaling (5.4% [2,106/38,837]).
Among oral AP prescriptions, penicillins accounted for 45.9% (1,757/3,829) and Watch group antibiotics accounted for 38.1% (1,459/3,829), with dental clinics prescribing significantly more Watch antibiotics than hospitals (OR 9.0; 95% CI 6.9–12.0; P<0.01).
Infective endocarditis developed in 1.8% (66/3,664) of patients (0.44% per person-year), with no significant difference in AP prescription rates between IDPs within 3 months before IE onset and those performed outside this period (OR 1.54; 95% CI 0.59–3.45; P=0.33).

Study Design

Type

Cross-Sectional (n=3,664)

Multicenter

Yes

Structured PICO

P

Population

3,664 patients in Kyoto, Japan with prosthetic heart valves (median age 76 years, 51.2% female) undergoing 52,247 invasive dental procedures, observed for a median of 54 months.

E

Exposure

Antibiotic prophylaxis (AP), defined as oral (80.0%) or intravenous (20.0%) antibiotics (predominantly penicillins [45.9%], WHO AWaRe Watch group antibiotics [38.1%] including macrolides, fluoroquinolones, and third-generation cephalosporins) prescribed within 7 days before the invasive dental procedure including the procedure day.

O

Outcome

Antibiotic prophylaxis (AP) prescription rate for various invasive dental procedures (IDPs) in patients with prosthetic heart valves

Limitations

Data derived from a single prefecture in Japan excluding individuals covered by employee health insurance, which may limit generalizability
Antibiotic indications and actual administration timing could not be determined from claims data
Information on detailed procedural characteristics, including bleeding risk, was unavailable
Microbiological data were unavailable, preventing assessment of causal relationships between invasive dental procedures, antibiotic prophylaxis, and infective endocarditis
Limited sample size in exploratory analysis of infective endocarditis and inability to account for repeated procedures or other established risk factors
Definition of invasive dental procedures differed slightly from previous studies (e.g., inclusion of periodontal examinations), which may have contributed to the lower overall adherence rate
Factors influencing non-adherence and interfacility variation (such as awareness of guidelines, staffing characteristics, and institutional formularies) could not be directly assessed from the claims database

Implication

Real-world claims data from Japan reveal a major evidence-practice gap in patients with prosthetic heart valves undergoing invasive dental procedures, characterized by low overall antibiotic prophylaxis rates (9.2%), frequent overuse of broad-spectrum 'Watch' antibiotics in dental clinics, and poor adherence to single-day pre-procedure dosing.

Abstract

Background: Patients with prosthetic heart valves (PHVs) are at high risk of infective endocarditis (IE). Although antibiotic prophylaxis (AP) is recommended for invasive dental procedures (IDPs), data on routine procedures and prescribing quality remain limited. This study investigated real-world AP practices across a broad range of IDPs and evaluated prescribing quality in patients with PHVs.

Discussion

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Cite This Study

Yamamoto et al. (2026) conducted a cross-sectional in Prosthetic heart valves undergoing invasive dental procedures (n=3,664). Invasive dental procedures was evaluated on Antibiotic prophylaxis prescription rate across invasive dental procedures. Antibiotic prophylaxis was prescribed in only 9.2% of 52,247 invasive dental procedures among patients with prosthetic heart valves, with dental clinics overusing Watch antibiotics (OR 9.0, P<0.01).

synapsesocial.com/papers/6ae7d421edffb4962941045f https://doi.org/10.1253/circj.cj-26-0476

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Antibiotic Prophylaxis During Invasive Dental Procedures in Patients With Prosthetic Heart Valves ― Cross-Sectional Analysis of Japanese Claims Data ―

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Antibiotic Prophylaxis During Invasive Dental Procedures in Patients With Prosthetic Heart Valves ― Cross-Sectional Analysis of Japanese Claims Data ―

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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