Incidence, Microbiology, and Outcomes in Patients Hospitalized With Infective Endocarditis
Incidence, Microbiology, and Outcomes in Patients Hospitalized With Infective Endocarditis
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DOI：
10.1161/circulationaha.119.044913
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发表时间：
2020-06-23
期刊：
影响因子：
37.8
通讯作者：
Cruden, Nicholas L.
中科院分区：
文献类型：
--
作者：
Shah, Anoop S., V;McAllister, David A.;Cruden, Nicholas L.
背景：尽管治疗方法不断改进，但感染性心内膜炎仍具有较高的发病率和死亡率。我们描述了感染性心内膜炎的发病率、微生物学和预后的时间变化，以及国家抗生素预防指南的变化对感染性心内膜炎的影响。研究方法：使用苏格兰范围内的个人水平联系方法，确定了1990年至2014年因感染性心内膜炎住院的所有患者，并将其与国家微生物学，处方以及发病率和死亡率数据集联系起来。关联数据用于评估感染性心内膜炎住院的粗发病率以及经年龄和性别调整的发病率和结局的趋势。从2008年开始，还分析了微生物学数据和根据患者人口统计学和合并症调整的相关结局。采用间断时间序列分析评价国家抗生素预防指南变更前后的发病率。结果：有7638例感染性心内膜炎住院（65 +/-17岁，51%为女性）。1990年至1995年期间，估计的粗住院率从5.3/100 000（95% CI，4.8 - 5.9）增加到8.6/100 000（95% CI，8.1 - 9.1），但此后保持稳定。2008年抗生素预防指南变更后，粗发病率无变化（相对风险变化1.06 [95%CI，0.94 - 1.20]）。从1990年至2014年，80岁以上患者的发病率翻了一番（17.7/100 000 [95% CI，13.4 - 23.3]至37.9/100 000 [95% CI，31.5 - 45.5]）。65岁女性患者的预测1年年龄和合并症校正病死率降低（27.3%[95% CI，24.6 - 30.2]至23.7%[95% CI，21.1 - 26.6]）和男性（30.7%[95% CI，27.7 - 33.8]至26.8%[95% CI，24.0 - 29.7]）。可获得2008年的血培养数据（n = 2267/7638，30%），42%（950/2267）记录了阳性血培养。金黄色葡萄球菌（403/950，42.4%）和肠球菌（337/950，35.5%）的1年死亡率最高（校正比值比分别为4.34 [95%CI，3.12 - 6.05]和3.41 [95%CI，2.04 - 5.70]）。结论：尽管抗生素预防指南发生了变化，但感染性心内膜炎的粗发病率保持稳定。然而，老年人的发病率增加了一倍。不到一半的患者血培养阳性，金黄色葡萄球菌和肠球菌菌血症与不良结局相关。
Background: Despite improvements in management, infective endocarditis remains associated with high mortality and morbidity. We describe temporal changes in the incidence, microbiology, and outcomes of infective endocarditis and the effect of changes in national antibiotic prophylaxis guidelines on incident infective endocarditis. Methods: Using a Scotland-wide, individual-level linkage approach, all patients hospitalized with infective endocarditis from 1990 to 2014 were identified and linked to national microbiology, prescribing, and morbidity and mortality datasets. Linked data were used to evaluate trends in the crude and age- and sex-adjusted incidence and outcomes of infective endocarditis hospitalizations. From 2008, microbiology data and associated outcomes adjusted for patient demographics and comorbidity were also analyzed. An interrupted time series analysis was performed to evaluate incidence before and after changes to national antibiotic prophylaxis guidelines. Results: There were 7638 hospitalizations (65 +/- 17 years, 51% females) with infective endocarditis. The estimated crude hospitalization rate increased from 5.3/100 000 (95% CI, 4.8-5.9) to 8.6/100 000 (95% CI, 8.1-9.1) between 1990 and 1995 but remained stable thereafter. There was no change in crude incidence following the 2008 change in antibiotic prophylaxis guidelines (relative risk of change 1.06 [95% CI, 0.94-1.20]). The incidence rate in patients >80 years of age doubled from 1990 to 2014 (17.7/100 000 [95% CI, 13.4-23.3] to 37.9/100 000 [95% CI, 31.5-45.5]). The predicted 1-year age- and comorbidity-adjusted case fatality rate for a 65-year-old patient decreased in women (27.3% [95% CI, 24.6-30.2] to 23.7% [95% CI, 21.1-26.6]) and men (30.7% [95% CI, 27.7-33.8] to 26.8% [95% CI, 24.0-29.7]) from 1990 to 2014. Blood culture data were available from 2008 (n=2267/7638, 30%), with positive blood cultures recorded in 42% (950/2267). Staphylococcus (403/950, 42.4%) and streptococcus (337/950, 35.5%) species were most common.Staphylococcus aureusand enterococcus had the highest 1-year mortality (adjusted odds ratio 4.34 [95% CI, 3.12-6.05] and 3.41 [95% CI, 2.04-5.70], respectively). Conclusions: Despite changes in antibiotic prophylaxis guidelines, the crude incidence of infective endocarditis has remained stable. However, the incidence rate has doubled in the elderly. Positive blood cultures were observed in less than half of patients, withStaphylococcus aureusand enterococcus bacteremia associated with worse outcomes.