Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis.
Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis.
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DOI：
10.1016/s0140-6736(14)62007-9
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发表时间：
2015-03-28
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影响因子：
--
通讯作者：
Thornhill MH
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文献类型：
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作者：
Dayer MJ;Jones S;Prendergast B;Baddour LM;Lockhart PB;Thornhill MH
在有感染性心内膜炎（IE）风险的患者中，在侵入性手术前给予抗生素预防（AP）历来是IE预防的重点。最近美国和欧洲AP指南的变化大大减少了推荐AP的人数。在英国，国家健康与护理卓越研究所（NICE）指南建议在2008年3月完全停止AP。我们报告这些指南对AP处方的影响;此外，IE发病率进行了检查后，介绍了指南。我们分析了2004年1月至2013年3月的英文AP处方数据和2000年1月至2013年3月初步诊断为IE的患者的出院事件统计数据。在引入NICE指南后，AP处方率急剧下降（10，935处方/月vs. 2，236处方/月，p<0.0001）。从2008年3月开始，IE病例数/月也显著增加（0.11例/1000万/月，CI 0.05 - 0.16，p<0.0001），高于预测的历史趋势。到2013年3月，如果以前的趋势继续下去，每月的案件数将比预期增加35起。IE发病率的增加对于“高风险”和“低风险”个体都是显著的。虽然我们的数据没有建立因果关系，但自2008年引入NICE指南以来，英格兰AP处方大幅减少，IE发病率显著增加。本研究的不同方面得到了英国心脏研究和Simplyhealth [Grant Ref：RG 2632/13/14]以及美国国立卫生研究院的NIDCR R 03资助[Ref：1 R 03 DE 023092 -01]的支持。
Antibiotic prophylaxis (AP) administered prior to invasive procedures in patients at risk of developing infective endocarditis (IE) has historically been the focus of IE prevention. Recent changes in AP guidelines in the US and Europe have substantially reduced the numbers for whom AP is recommended. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommended complete cessation of AP in March 2008. We report the impact of these guidelines on AP prescribing; in addition, IE incidence was examined following the introduction of the guidelines. We analyzed English AP prescribing data from January 2004 to March 2013 and hospital discharge episode statistics for patients with a primary diagnosis of IE from January 2000 to March 2013. AP prescribing rates fell dramatically after introduction of the NICE guidance (10,935 prescriptions/month vs. 2,236 prescriptions/month, p<0·0001). Commencing in March 2008, there was also a significant increase in the number of IE cases/month (0·11 cases/10million/month, CI 0·05–0·16, p<0·0001) above the projected historical trend. By March 2013, there were an additional 35 cases/month than would have been expected if the previous trend had continued. This increase in IE incidence was significant for both ‘high-risk’ and ‘lower-risk’ individuals. Although our data do not establish a causal relationship, there has been a substantial reduction in AP prescribing and a significant increase in IE incidence in England since introduction of the NICE guidelines in 2008. Different aspects of this study were supported by Heart Research UK and Simplyhealth [Grant Ref: RG2632/13/14] and NIDCR R03 grant [Ref: 1R03DE023092-01] from the National Institutes for Health.