Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

Thirty-five more cases of infective endocarditis reported per month in England.

Main

DayerMJ,JonesS etal.Lancet 2014;10.1016/S0140-6736(14)62007-9(Epubaheadofprint:http://dx.doi.org/10.1016/S0140-6736(14)62007-9)

The oral viridans group of streptococci have been associated with infective endocarditis in 35–45% of patients. Yet there is no evidence to support the use of antibiotic prophylaxis in the prevention of infective endocarditis.

In March 2008, NICE recommended cessation of antibiotic prophylaxis for the prevention of infective endocarditis for patients receiving dental treatment resulting in a bacteraemia. Similar advice has been given in the USA and elsewhere in Europe for patients at moderate risk only of infective endocarditis. But for those at high risk of infective endocarditis ('previous infective endocarditis, prosthetic heart valves or valves repaired with prosthetic material, unrepaired cyanotic congenital heart disease, or some repaired congenital heart defects') in the USA and elsewhere in Europe, antibiotic prophylaxis is still recommended (search Infective Endocarditis – American Heart Association).

The investigators of this high impact research report the results of a retrospective secular trend study. It examined the effect that stopping antibiotic prophylaxis had on the incidence of infective endocarditis, cogent that any change may not only be as a consequence of this intervention. Using data from hospital discharge episode statistics, the number of patients who were diagnosed with infective endocarditis between 2000 and 2013, including those who died, were quantified. And the number of prescriptions for antibiotic prophylaxis between January 2004 and March 2013 were obtained from data from the National Health Service Business Services Authority. Segmented regression analysis of the interrupted time series was used to compare the incidence of infective endocarditis before and after the introduction of the NICE guidelines.

In those months before the NICE guidance, 10,900 prescriptions each month were made for antibiotic prophylaxis. From April 2008, the mean number of prescriptions dropped dramatically to 2,236 each month (p <0.001).

The key finding from this study is that the true numbers of infective endocarditis increased significantly above the projected historical trend (95% CI 0.05–0.16, p <0.0001 – range within which the true treatment effect is likely to occur). This increase in the number of patients with infective endocarditis has affected individuals from both high-risk and lower-risk groups.

Infective endocarditis has both a high morbidity and mortality. No causal relationship was established.