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

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:59

Article

Duval, Xavier^1,2,3  Delahaye, Francois^4,5  Alla, Francois^6,7  Tattevin, Pierre⁸  Obadia, Jean-Francois⁹  Le Moing, Vincent^10,11  Doco-Lecompte, Thanh⁶  Celard, Marie¹²  Poyart, Claire^13,14,15  Strady, Christophe¹⁶  Bes, Michelle¹²  Cambau, Emmanuelle¹⁸  Iung, Bernard¹⁹  Hoen, Bruno^17,20 

[1] Hop Univ Bichat, AP HP, INSERM, CIC 007, Paris, France

[2] INSERM, U738, Paris, France

[3] Univ Paris 07, UFR Med, F-75877 Paris 18, France

[4] Hosp Civils Lyon, Lyon, France

[5] Univ Lyon 1, F-69365 Lyon, France

[6] Ctr Hosp Univ Nancy, Nancy, France

[7] Univ Nancy, EA 4003, Nancy, France

[8] Hop Univ Pontchaillou, Unite Soins Intensifs & Malad Infect, Rennes, France

[9] Hop Louis Pradel, Bron, France

[10] Ctr Hosp Reg Univ Montpellier, Serv Malad Infect & Trop, Montpellier, France

[11] Univ Montpellier I, Inst Rech Dev, UMR 145, Montpellier, France

[12] Ctr Natl Reference Staphylocoques, Lab Bacteriol, Bron, France

[13] Hop Cochin, AP HP, Serv Bacteriol, CNR Strep, F-75674 Paris, France

[14] Univ Paris 05, Fac Med, Inst Cochin, CNRS,UMR 8104, F-75014 Paris, France

[15] INSERM, U1016, Paris, France

[16] Hop Robert Debre, CHU Reims, Serv Med Interne & Malad Infect & Trop, F-75019 Paris, France

[17] CHU Besancon, F-25030 Besancon, France

[18] Hop St Louis, AP HP, Paris, France

[19] Hop Univ Bichat, AP HP, Dept Cardiol, Paris, France

[20] Univ Franche Comte, CNRS, UMR Chronoenvironm, F-25030 Besancon, France

关键词: epidemiology;    infective endocarditis;    population-based;    prophylaxis;    staphylococci;   

DOI  :  10.1016/j.jacc.2012.02.029

来源: Elsevier

【 摘 要 】

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 >= 20 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. (J Am Coll Cardiol 2012; 59: 1968-76) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

Free