Dental Exposure and Oral-Flora-Associated Infective Endocarditis: A Transoesophageal Echocardiography-Based Study at a Teaching District General Hospital in the United Kingdom.

Background Infective endocarditis (IE) remains associated with substantial morbidity and mortality despite advances in diagnosis and treatment. Transoesophageal echocardiography (TOE) is central to the diagnosis of IE; however, contemporary data examining the relationships among dental exposure, microbiological findings, and echocardiographic characteristics in routine clinical practice remain limited, particularly in district general hospitals (DGHs). Methods We conducted a retrospective observational study of consecutive TOE examinations performed for suspected IE at Royal Derby Hospital, a United Kingdom (UK) teaching DGH, between April 2022 and October 2024. A total of 145 consecutive TOE examinations performed for suspected IE were screened. Twelve examinations were excluded because IE was not confirmed or because they were duplicate or repeat examinations relating to the same infective episode, leaving 133 unique confirmed clinical episodes of IE for the final analysis. Demographic, microbiological, echocardiographic, treatment, and outcome data were collected retrospectively. The primary analysis evaluated the association between documented dental procedures and oral flora-associated IE, while secondary analyses described echocardiographic findings, microbiological profiles, surgical intervention, and in-hospital mortality. Results Among the 133 unique confirmed clinical episodes of IEepisodes, the mean patient age was 63.3 years, and 66.2% of patients were male. Native-valve IE accounted for 75.9% of cases. The aortic valve was the most frequently affected structure (62.4%), while Staphylococcus aureus was the predominant causative organism (30.8%). Oral flora organisms accounted for 33.1% of infections. Twenty-six patients (19.5%) underwent surgical or device intervention, and the in-hospital mortality rate was 11.3%. Among the 26 patients with documented dental procedures, antibiotic prophylaxis was documented for two (7.7%). Documented dental procedures were associated with a higher frequency of oral flora-associated IE (50.0% vs. 28.8%; odds ratio, 2.47; 95% confidence interval, 1.03-5.94; p = 0.040). No clinical, microbiological, or echocardiographic variable demonstrated a significant association with in-hospital mortality. Conclusions In this contemporary cohort of patients with confirmed IE who underwent TOE, documented dental exposure was significantly associated with oral flora-associated IE. The study also demonstrates that aortic valve involvement, Staphylococcus aureus infection, and native-valve disease remain common in routine UK practice. The low rate of documented antibiotic prophylaxis may highlight an opportunity to improve documentation, although prospective studies are needed to determine the true rate of prophylaxis administration.