美国 2000 年至 2011 年感染性心内膜炎发病率、微生物学和瓣膜置换的趋势。

Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011.

机构信息

Department of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.

Department of Internal Medicine, Staten Island University, Staten Island, New York.

出版信息

J Am Coll Cardiol. 2015 May 19;65(19):2070-6. doi: 10.1016/j.jacc.2015.03.518.

DOI:10.1016/j.jacc.2015.03.518

PMID:25975469

Abstract

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.

摘要

背景

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极少数心脏疾病，这些疾病因 IE 而导致不良后果的风险极高。然而，自美国这一重大实践改变以来，IE 趋势的数据很少。

目的

本研究旨在比较 2007 年 IE 预防指南改变前后美国 IE 发病率、微生物学和结局的时间趋势。

方法

利用全国住院患者样本数据库（NIS）调查了 2000 年至 2011 年美国 IE 住院率。采用分段回归分析比较 2007 年指南改变前后平均年 IE 发生率。

结果

2000 年至 2011 年美国有 457052 例 IE 相关住院治疗，发病率呈稳步上升趋势（p < 0.001）。2000 年至 2007 年和 2008 年至 2011 年的 IE 住院率趋势无显著差异（p = 0.74）。研究期间每百万人口中金黄色葡萄球菌 IE 病例数的增加相似（p = 0.13），但新指南发布后链球菌 IE 住院率显著升高（p = 0.002）。最后，IE 瓣膜置换率从 2000 年至 2007 年稳步上升（p = 0.03），但从 2007 年至 2011 年趋于平稳。总体而言，新指南发布前后 IE 瓣膜置换率无显著差异（p = 0.23）。