Procedures associated with infective endocarditis in adults - A case control study
Procedures associated with infective endocarditis in adults - A case control study
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DOI：
10.1093/oxfordjournals.eurheartj.a060855
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发表时间：
1995-12-01
影响因子：
39.3
通讯作者：
Briancon, S
中科院分区：
文献类型：
--
作者：
Lacassin, F;Hoen, B;Briancon, S
目的：通过病例对照研究，评价不同手术方式并发感染性心内膜炎的相对危险性及抗生素预防的保护效果。背景：预防感染性心内膜炎的建议是基于手术与感染性心内膜炎之间关系的假设，这一假设得到了轶事报道和实验模型数据的支持。方法：经超声心动图和肉眼检查，符合Von Reyn诊断标准。对照组从心脏病科或内科病房招募。病例（n = 171）和对照组在性别、年龄和潜在心脏病方面相匹配。他们被要求说明在过去3个月内的所有内科、外科或牙科手术。在潜在的混杂因素中，报告了前3个月的感染事件和皮肤伤口。记录抗生素预防给药的类型、剂量、持续时间和给药计划。结果：病例接受至少一次手术的频率明显高于对照组（匹配优势比为1.6,95%置信区间为1.01至2.53）。整体来看，牙科手术与增加的风险无关，尽管洗牙和根管治疗显示出感染性心内膜炎风险增加的趋势（P = 0.065）。在非牙科手术中，只有手术存在风险（匹配优势比为4.7,95%可信区间为1.02 - 22）。考虑到所有手术，感染性心内膜炎的风险随着手术次数的增加而显著增加。虽然两组之间的一般合并症没有差异，但感染发作或皮肤伤口的病例明显多于对照组。在多变量分析中，只有感染性发作和皮肤伤口显著增加了感染性心内膜炎的风险。结垢是翠绿链球菌感染性心内膜炎的唯一独立危险因素。46%的抗生素预防保护效果不显著。结论：手术确实增加了感染性心内膜炎的风险。对与牙科手术相关的明显低风险的解释可能是当前抗生素预防实践的结果。我们的数据表明，在未来的指南中应该更明确地提到手术，并再次强调对心脏患者的任何局灶性感染的严格治疗是强制性的。从抗生素预防的有效率可以估计，在法国，如果心脏病患者适当使用抗生素预防，感染性心内膜炎的总发病率可能会降低5 - 10%。
Object: To assess the relative risk of infective endocarditis associated with various procedures and the protective efficacy of antibiotic prophylaxis by a case-control study.Background: Recommendations for the prevention of infective endocarditis are based on the hypothesis of a relationship between procedures and infective endocarditis which is supported by anecdotal reports and data from experimental models.Methods: Cases met the Von Reyn's diagnostic criteria modified with echocardiographic and macroscopic findings. Controls were recruited from cardiology or medicinal wards. Cases (n = 171) and controls were matched as regards sex, age and underlying cardiac condition. They were requested to indicate all the medical, surgical or dental procedures within the previous 3 months. Among potential confounding factors, infectious episodes and skin wounds in the previous 3 months were reported. Antibiotic prophylaxis administration was documented for type, dosage, duration and administration schedule.Results: Cases significantly more frequently than controls had undergone at least one procedure (matched odds ratio, 1.6, 95% confidence interval, 1.01 to 2.53). Dental procedures considered as a whole were not associated with an increased risk, although scaling and root canal treatment showed a trend towards a higher risk of infective endocarditis (P = 0.065). Among non-dental procedures, only surgery appeared to be at risk (matched odds ratio, 4.7, 95% confidence interval, 1.02 to 22). Considering all procedures, the risk of infective endocarditis increased significantly with the number of procedures. While general co-morbid conditions did not differ between the two groups, cases significantly more frequently than controls had experienced an infectious episode or a skin wound. In multivariate analysis, only infectious episodes and skin wounds significantly increased the risk of infective endocarditis. Scaling was the only independent risk factor for viridans streptococcal infective endocarditis. The 46% protective efficacy of antibiotic prophylaxis was not significant.Conclusions: Procedures do increase the risk of infective endocarditis. The interpretation of the apparent low risk associated with dental procedures may be as a result of the current practice of antibiotic prophylaxis. Our data suggest that surgery should be more clearly mentioned in future guidelines, and reemphasize that a rigorous treatment of any focal infection in cardiac patients is mandatory. From the efficacy rate of antibiotic prophylaxis, it can be estimated that the overall incidence of infective endocarditis might be reduced by 5 to 10% in France by appropriate use of antibiotic prophylaxis in cardiac patients.