Dayer Mark J, Jones Simon, Prendergast Bernard, Baddour Larry M, Lockhart Peter B, Thornhill Martin H
Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, Somerset, UK.
Integrated Care Research, University of Surrey, Guildford, Surrey, UK.
Lancet. 2015 Mar 28;385(9974):1219-28. doi: 10.1016/S0140-6736(14)62007-9. Epub 2014 Nov 18.
Antibiotic prophylaxis given before invasive dental procedures in patients at risk of developing infective endocarditis has historically been the focus of infective endocarditis prevention. Recent changes in antibiotic prophylaxis guidelines in the USA and Europe have substantially reduced the number of patients for whom antibiotic prophylaxis is recommended. In the UK, guidelines from the National Institute for Health and Clinical Excellence (NICE) recommended complete cessation of antibiotic prophylaxis for prevention of infective endocarditis in March, 2008. We aimed to investigate changes in the prescribing of antibiotic prophylaxis and the incidence of infective endocarditis since the introduction of these guidelines.
We did a retrospective secular trend study, analysed as an interrupted time series, to investigate the effect of antibiotic prophylaxis versus no prophylaxis on the incidence of infective endocarditis in England. We analysed data for the prescription of antibiotic prophylaxis from Jan 1, 2004, to March 31, 2013, and hospital discharge episode statistics for patients with a primary diagnosis of infective endocarditis from Jan 1, 2000, to March 31, 2013. We compared the incidence of infective endocarditis before and after the introduction of the NICE guidelines using segmented regression analysis of the interrupted time series.
Prescriptions of antibiotic prophylaxis for the prevention of infective endocarditis fell substantially after introduction of the NICE guidance (mean 10,900 prescriptions per month [Jan 1, 2004, to March 31, 2008] vs 2236 prescriptions per month [April 1, 2008, to March 31, 2013], p<0·0001). Starting in March, 2008, the number of cases of infective endocarditis increased significantly above the projected historical trend, by 0·11 cases per 10 million people per month (95% CI 0·05-0·16, p<0·0001). By March, 2013, 35 more cases per month were reported than would have been expected had the previous trend continued. This increase in the incidence of infective endocarditis was significant for both individuals at high risk of infective endocarditis and those at lower risk.
Although our data do not establish a causal association, prescriptions of antibiotic prophylaxis have fallen substantially and the incidence of infective endocarditis has increased significantly in England since introduction of the 2008 NICE guidelines.
Heart Research UK, Simplyhealth, and US National Institutes of Health.
对于有感染性心内膜炎发病风险的患者，在侵入性牙科操作前给予抗生素预防，一直以来都是感染性心内膜炎预防的重点。美国和欧洲近期对抗生素预防指南的修订，已大幅减少了推荐进行抗生素预防的患者数量。在英国，国家卫生与临床优化研究所（NICE）的指南于2008年3月建议完全停止使用抗生素预防来预防感染性心内膜炎。我们旨在调查自这些指南出台以来抗生素预防处方的变化以及感染性心内膜炎的发病率。
我们进行了一项回顾性长期趋势研究，作为中断时间序列进行分析，以调查抗生素预防与不预防对英格兰感染性心内膜炎发病率的影响。我们分析了2004年1月1日至2013年3月31日期间抗生素预防的处方数据，以及2000年1月1日至2013年3月31日期间初次诊断为感染性心内膜炎患者的医院出院情况统计数据。我们使用中断时间序列的分段回归分析比较了NICE指南出台前后感染性心内膜炎的发病率。
NICE指南出台后，用于预防感染性心内膜炎的抗生素处方大幅减少（2004年1月1日至2008年3月31日期间平均每月10900张处方，而2008年4月1日至2013年3月31日期间为每月2236张处方，p<0.0001）。从2008年3月开始，感染性心内膜炎病例数显著高于预测的历史趋势，每月每1000万人增加0.11例（95%置信区间0.05 - 0.16，p<0.0001）。到2013年3月，每月报告的病例数比如果之前的趋势持续下去所预期的多35例。感染性心内膜炎发病率的这种增加在感染性心内膜炎高风险个体和低风险个体中均有统计学意义。
尽管我们的数据未确立因果关系，但自2008年NICE指南出台以来，英格兰的抗生素预防处方已大幅下降，而感染性心内膜炎的发病率显著上升。
英国心脏研究协会、Simplyhealth和美国国立卫生研究院。
