N
ews and
E
vents
Rise in incidenceof infective
endocarditis followsdrop in
antibioticuse
Usingnational dataonhospital episode statistics,
whichcapture records for admittedpatients,
outpatients, accidents andemergencies, researchers
identifiedclose to20,000patientswithaprimary
diagnosisof IEover about 13years (8yearsbefore
theguidelines and5years afterwards). After the
NICEguidelineswere implemented, the incidenceof
IE—whichhadbeen trendingupward—significantly
increased. At theendof the study, researchers
estimated therewerealmost 35morecasesof IEper
month thanwouldhavebeenexpectedgivenhistorical
trends. Bothhigh-riskand lower-risk individualswere
affectedby this increase.
Caution againstdrawing strong
conclusions
In response to the study,
TheLancet
alsopublisheda
commentary
5
that noted the study’s limitations and
cautionedagainst drawing strongconclusions—similar
topointsmadeby the studyauthors themselves. “The
follow-upcomment notedother potential andplausible
reasons for the increase in incidenceof IE, suchas an
ageingpopulationandan increasedprevalenceof
peoplewith intracardiacdevices,” saysDr. Quiñonez.
“Inaddition, oneof the limitationsof usinghospital
dischargedata is that it isunknownwhether newcases
of IEwere the result of oral streptococcal bacteria.”
The studyauthors call for further research toassess
whether similar trends canbe found inother
populations. In light of thesefindings, NICEannounced
an immediate reviewof its 2008guideline.
a
References
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endocarditis inEngland,2000–13:aseculartrend, interruptedtime-seriesanalysis.2014;The
Lancet.EarlyOnlinePublication;18Nov2014,doi:10.1016/S0140-6736(14)62007-9.
2.National Institute forHealthandClinicalExcellence.Prophylaxisagainst infectiveendocarditis:
antimicrobialprophylaxisagainst infectiveendocarditis inadultsandchildrenundergoing
interventionalprocedures.NICEClinicalGuidelineNo64.London:National Institute forHealthand
ClinicalExcellence,2008.
3.CanadianDentalAssociation.CDApositiononpreventionof infectiveendocarditis[accessed2
Dec2014].Available:http://www.cda-adc.ca/_files/position_statements/infectiousEndocarditis.pdf
4.AmericanHeartAssociation.Preventionof infectiveendocarditis:guidelines fromtheAmerican
HeartAssociation:aguideline fromtheAmericanHeartAssociationRheumaticFever,Endocarditis,
andKawasakiDiseaseCommittee,CouncilonCardiovascularDisease intheYoung,andtheCouncil
onClinicalCardiology,CouncilonCardiovascularSurgeryandAnesthesia,andtheQualityofCare
andOutcomesResearch InterdisciplinaryWorkingGroup.Circulation.2007;116(15):1736-54.Epub
2007Apr19.
5.DuvalX,HoenB.Prophylaxis for infectiveendocarditis: let’sendthedebate.TheLancet.18Nov
2014,doi:10.1016/S0140-6736(14)62121-8.
