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Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications
JACC - Journal of the American College of Cardiology, 06/05/2012
Clinical Guideline
Duval X et al. – Scaling down antibiotic prophylaxis indications was not associated with an increased incidence of oral streptococcal infective endocarditis (IE). A focus on avoidance of S. aureus bacteremia in all patients, including those with no previously known valve disease, will be required to improve IE prevention.
Methods- Three 1–year population–based surveys were conducted in 1991, 1999, and 2008 in 3 French regions totaling 11 million inhabitants age ≥20 years.
- Authors prospectively collected IE cases from all medical centers and analyzed age– and sex–standardized IE annual incidence trends.
- Overall, 993 expert–validated IE cases were analyzed (323 in 1991; 331 in 1999; and 339 in 2008).
- IE incidence remained stable over time (95% confidence intervals given in parentheses/brackets): 35 (31 to 39), 33 (30 to 37), and 32 (28 to 35) cases per million in 1991, 1999, and 2008, respectively.
- Oral streptococci IE incidence did not increase either in the whole patient population (8.1 [6.4 to 10.1], 6.3 [4.8 to 8.1], and 6.3 [4.9 to 8.0] in 1991, 1999, and 2008, respectively) or in patients with pre–existing native valve disease.
- The increased incidence of Staphylococcus aureus IE (5.2 [3.9 to 6.8], 6.8 [5.3 to 8.6], and 8.2 [6.6 to 10.2]) was not significant in the whole patient population (p = 0.228) but was significant in the subgroup of patients without previously known native valve disease (1.6 [0.9 to 2.7], 3.7 [2.6 to 5.1], and 4.1 [3.0 to 5.6]; p = 0.012).
