Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim, Norway.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
J Am Coll Cardiol. 2018 Jun 19;71(24):2744-2752. doi: 10.1016/j.jacc.2018.03.532.
Various invasive medical procedures might induce bacteremia and, hence, act as triggers for infective endocarditis. However, empirical data in humans on the potential dangers of invasive medical procedures in this regard are very sparse. Due to lack of sufficient data, it is currently debated whether the risk for endocarditis with medical procedures is substantial or rather negligible.
The purpose of this nationwide case-crossover study was to quantify the excess risk for infective endocarditis in association with invasive medical and surgical procedures.
The authors identified all adult patients treated for endocarditis in hospitals in Sweden between January 1, 1998, and December 31, 2011. The authors applied a case-crossover design and compared the occurrence of invasive medical procedures 12 weeks before endocarditis with a corresponding 12-week time period exactly 1 year earlier. The authors considered all invasive nondental medical procedures except for those that are likely to be undertaken due to endocarditis or sepsis or due to infections that could possibly lead to endocarditis.
The authors identified 7,013 cases of infective endocarditis during the study period. Among others, several cardiovascular procedures, especially coronary artery bypass grafting; procedures of the skin and management of wounds; transfusion; dialysis; bone marrow puncture; and some endoscopies, particularly bronchoscopy, were strongly associated with an increased risk for infective endocarditis.
This study suggests that several invasive nondental medical procedures are associated with a markedly increased risk for infective endocarditis.
各种有创的医疗操作都可能引发菌血症，并由此成为感染性心内膜炎的触发因素。然而，人类在这方面有关有创医疗操作潜在危险的经验数据非常有限。由于缺乏充分的数据，目前仍在争论有创医疗操作引发心内膜炎的风险是实质性的还是可以忽略不计的。
本项全国性病例交叉研究的目的是量化与有创医疗和外科操作相关的心内膜炎感染的额外风险。
研究者确定了在瑞典医院接受心内膜炎治疗的所有成年患者，时间为 1998 年 1 月 1 日至 2011 年 12 月 31 日。研究者采用病例交叉设计，将心内膜炎发生前 12 周的有创医疗操作与恰好 1 年前的同期 12 周进行比较。研究者考虑了所有有创的非牙科医疗操作，但不包括那些可能因心内膜炎或败血症而进行的操作，或因可能导致心内膜炎的感染而进行的操作。
研究者在研究期间确定了 7013 例感染性心内膜炎病例。其中，一些心血管操作，特别是冠状动脉旁路移植术；皮肤和伤口管理程序；输血；透析；骨髓穿刺术；以及一些内窥镜检查，特别是支气管镜检查，与感染性心内膜炎风险的显著增加相关。
本研究表明，几种有创的非牙科医疗操作与感染性心内膜炎的风险显著增加相关。
