Bacterial endocarditis linked to an oral surgery practice

In October 2015, the New Jersey Department of Health (NJDOH) indicated that it had received reports of three patients who developed Enterococcus faecalis endocarditis after undergoing surgical procedures at the same oral surgery practice. The NJDOH immediately conducted retroactive surveillance to identify other possible cases. Departmental public health specialists inspected the practice, interviewed staff members and reviewed medical records.¹

To identify additional patients with bacterial endocarditis, appointment records initially were reviewed for 2013−2014. Later, this was extended through to mid-2016. Patients listed were compared to discharge records from state inpatient hospitalizations and emergency department visits. Patients with diagnostic billing codes for endocarditis or enterococcal infection were selected.

A confirmed case was a patient of the practice who received a diagnosis of infective endocarditis and a documented E. faecalis bacteremia within 6 months after an oral surgery procedure. All confirmed cases were interviewed and their clinical course reviewed, which included all possible sources of enteroccocal infection. The number of oral surgery visits, types of procedures performed and medications administered were determined for the matched patients. Officials then sent email notifications to all New Jersey healthcare providers asking them to report any cases of endocarditis or enterococcal infection.