Temporal Trends in Infective Endocarditis in the Context of Prophylaxis Guideline Modifications: Three Successive Population-Based Surveys

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• 作者：Xavier Duval ; MD ; PhD^鈦?/sup> ; ^&dagger ; ; ^&Dagger ; ; ^{xavier.duval@bch.aphp.fr} ; Franç ; ois Delahaye ; MD ; PhD^§ ; ; ^鈭?/sup> ; Franç ; ois Alla ; MD ; PhD^¶ ; ; ^# ; Pierre Tattevin ; MD ; PhD^鈦庘亷 ; Jean-Franç ; ois Obadia ; MD ; PhD^&dagger ; &dagger ; ; Vincent Le Moing ; MD ; PhD^&Dagger ; &Dagger ; ; ^§ ; § ; ; Thanh Doco-Lecompte ; MD^¶ ; ; Marie Celard ; MD^鈭モ垾 ; Claire Poyart ; MD ; PhD^¶ ; ¶ ; ; ^## ; ^{鈦庘亷鈦?/sup>} ; Christophe Strady ; MD ; PhD^&dagger ; &dagger ; &dagger ; ; Catherine Chirouze ; MD^&Dagger ; &Dagger ; &Dagger ; ; Michelle Bes ; PhD^鈭モ垾 ; Emmanuelle Cambau ; MD ; PhD^&Dagger ; ; ^§ ; § ; § ; ; Bernard Iung ; MD^&Dagger ; ; ^{鈭モ垾鈭?/sup>} ; Christine Selton-Suty ; MD^¶ ; ; Bruno Hoen ; MD ; PhD^&Dagger ; &Dagger ; &Dagger ; ; ^¶ ; ¶ ; ¶ ; ; AEPEI Study Group
• 关键词：epidemiology ; infective endocarditis ; population-based ; prophylaxis ; staphylococci
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 期刊代码：201_07351097
• 类别：med
• 出版时间：29 May, 2012
• 卷：59
• 期：22
• 页码：1968-1976
• 文件大小：1008 K

摘要

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Objectives

The goal of this study was to evaluate temporal trends in infective endocarditis (IE) incidence and clinical characteristics after 2002 French IE prophylaxis guideline modifications.

Background

There are limited data on changes in the epidemiology of IE since recent guidelines recommended restricting the indications of antibiotic prophylaxis of IE.

Methods

Three 1-year population-based surveys were conducted in 1991, 1999, and 2008 in 3 French regions totaling 11 million inhabitants age 鈮?0 years. We prospectively collected IE cases from all medical centers and analyzed age- and sex-standardized IE annual incidence trends.

Results

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).

Conclusions

Scaling down antibiotic prophylaxis indications was not associated with an increased incidence of oral streptococcal 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.