Trends in Infective Endocarditis Incidence, Microbiology, and Valve Replacement in the United States From 2000 to 2011
Trends in Infective Endocarditis Incidence, Microbiology, and Valve Replacement in the United States From 2000 to 2011
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DOI：
10.1016/j.jacc.2015.03.518
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发表时间：
2015-05-19
影响因子：
24
通讯作者：
Mehta, Jawahar L.
中科院分区：
文献类型：
--
作者：
Pant, Sadip;Patel, Nileshkumar J.;Mehta, Jawahar L.
根据2007年美国心脏病学会和美国心脏协会感染性心内膜炎（IE）指南更新，抗生素预防现在仅限于少数IE不良结局风险极高的心脏疾病。然而，自从美国这一重大实践变化以来，关于IE趋势的数据很少。在美国2007年IE预防指南变更前后的结果。（全国住院患者样本）数据库用于调查2000年至2011年美国IE住院率。使用分段回归分析比较2007年指南变更前后IE的平均年发病率。结果从2000年到2011年，美国有457，052例IE相关住院，发病率稳步上升（p < 0.001）。2000年至2007年和2008年至2011年IE住院率的趋势无显著差异（p = 0.74）。在2000年至2007年和2008年至2011年的研究期间，每百万人口中葡萄球菌IE病例数的增加相似（p = 0.13），但在新指南发布后，链球菌IE住院率显著升高（p = 0.002）。最后，IE的瓣膜置换率从2000年到2007年稳步增加（p = 0.03），但从2007年到2011年显示出平台期。总的来说，有没有显着差异，在新的指南发布之前和之后的IE的瓣膜置换率（p = 0.23）。结论这些结果表明，IE的发病率在美国在过去的十年中有所增加。关于IE的微生物学，自2007年指南修订以来，链球菌IE的发病率显著上升。然而，自2007年IE预防指南变更以来，IE的住院率和瓣膜手术率并未增加。(C)2015年由美国心脏病学会基金会。
BACKGROUND In accordance with the 2007 American College of Cardiology and American Heart Association infective endocarditis (IE) guideline update, antibiotic prophylaxis is now being restricted to a smaller number of cardiac conditions with very high risk for adverse outcomes from IE. However, there is scant data on IE trends since this major practice change in the United States.OBJECTIVES The aim of this study was to compare temporal trends in IE incidence, microbiology, and outcomes before and after the change in the 2007 IE prophylaxis guideline in the United States.METHODS The NIS (Nationwide Inpatient Sample) database was used to investigate IE hospitalization rates in the United States from 2000 through 2011. The mean annual rates of IE before and after the 2007 guideline change were compared using segmented regression analysis.RESULTS There were 457,052 IE-related hospitalizations in the United States from 2000 to 2011, with a steady increase in incidence (p < 0.001). The trend in IE hospitalization rates from 2000 to 2007 and from 2008 to 2011 was not significantly different (p = 0.74). The increases in the number of Staphylococcus IE cases per million population during the study periods 2000 to 2007 and 2008 to 2011 were similar (p = 0.13), but Streptococcus IE hospitalization rates were significantly higher after the release of new guidelines (p = 0.002). Finally, valve replacement rates for IE steadily increased from 2000 to 2007 (p = 0.03) but showed a plateau from 2007 to 2011. Overall, there was no significant difference in the rates of valve replacement for IE before and after the release of new guideline (p = 0.23).CONCLUSIONS These results show that IE incidence has increased in the United States over the past decade. With regard to the microbiology of IE, there has been a significant rise in the incidence of Streptococcus IE since the 2007 guideline revisions. However, the rates of hospitalization and valve surgery for IE have not increased since the change in IE prophylaxis guideline in 2007. (C) 2015 by the American College of Cardiology Foundation.