Sakai Bizmark Rie, Chang Ruey-Kang R, Tsugawa Yusuke, Zangwill Kenneth M, Kawachi Ichiro
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Boston, MA; Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Boston, MA; Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
Am Heart J. 2017 Jul;189:110-119. doi: 10.1016/j.ahj.2017.04.006. Epub 2017 Apr 18.
Use a nationally representative sample to assess impacts of new clinical guidelines issued by the American Heart Association (AHA) in 2007 for many types of invasive procedures, with recommendations for significant decreases in antimicrobial prophylaxis use.
Interrupted time series analyses of pediatric hospitalizations for Infective Endocarditis (IE), using the Nationwide Inpatient Sample (NIS) ICD-9-CM diagnostic codes, identified IE hospitalizations for patients <18 years old from 2001 to 2012. Changes in IE incidence before and after 2007 AHA guidelines were evaluated, with differences in IE clinical severity assessed using in-hospital mortality and length of stay. Analyses were stratified by pathogen type and age group (0-9 y/o and 10-17 y/o).
With 3,748 patients in the study, we observed rising trends in IE incidence, but no significant difference between pre- and post-guideline. There was a significant trend increase for IE due to viridans group streptococci (VGS) for ages >10 years old, comparing pre-guideline to post-guideline periods, but not in children 0-9 years of age. Neither in-hospital mortality nor length of stay changed significantly during study.
The data did not demonstrate an impact of the 2007 guideline changes on overall incidence of pediatric IE. However, a significant increase in disease incidence trend due to VGS was observed for the 10-17 year-old group, compared pre- and post-guideline.
使用具有全国代表性的样本，评估美国心脏协会（AHA）2007年发布的针对多种侵入性操作的新临床指南的影响，这些指南建议大幅减少抗菌药物预防的使用。
采用中断时间序列分析方法，对感染性心内膜炎（IE）患儿的住院情况进行分析，使用全国住院患者样本（NIS）的ICD - 9 - CM诊断代码，确定2001年至2012年18岁以下患者的IE住院情况。评估2007年AHA指南前后IE发病率的变化，并使用住院死亡率和住院时间评估IE临床严重程度的差异。分析按病原体类型和年龄组（0 - 9岁和10 - 17岁）分层。
本研究共纳入3748例患者，我们观察到IE发病率呈上升趋势，但指南前后无显著差异。与指南前相比，10岁以上儿童由草绿色链球菌（VGS）引起的IE发病率有显著上升趋势，但0 - 9岁儿童无此现象。研究期间，住院死亡率和住院时间均无显著变化。
数据未显示2007年指南变更对小儿IE总体发病率有影响。然而，与指南前相比，10 - 17岁组因VGS导致的疾病发病率趋势显著增加。
