Unit of Oral & Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom; Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina.
Truven Health Analytics/IBM Watson Health, Ann Arbor, Michigan.
J Am Coll Cardiol. 2018 Nov 13;72(20):2443-2454. doi: 10.1016/j.jacc.2018.08.2178. Epub 2018 Nov 5.
The American Heart Association updated its recommendations for antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) in 2007, advising that AP cease for those at moderate risk of IE, but continue for those at high risk.
The authors sought to quantify any change in AP prescribing and IE incidence.
High-risk, moderate-risk, and unknown/low-risk individuals with linked prescription and Medicare or commercial health care data were identified in the Truven Health MarketScan databases from May 2003 through August 2015 (198,522,665 enrollee-years of data). AP prescribing and IE incidence were evaluated by Poisson model analysis.
By August 2015, the 2007 recommendation change was associated with a significant 64% (95% confidence interval [CI]: 59% to 68%) estimated fall in AP prescribing for moderate-risk individuals and a 20% (95% CI: 4% to 32%) estimated fall for those at high risk. Over the same period, there was a barely significant 75% (95% CI: 3% to 200%) estimated increase in IE incidence among moderate-risk individuals and a significant 177% estimated increase (95% CI: 66% to 361%) among those at high risk. In unknown/low-risk individuals, there was a significant 52% (95% CI: 46% to 58%) estimated fall in AP prescribing, but no significant increase in IE incidence.
AP prescribing fell among all IE risk groups, particularly those at moderate risk. Concurrently, there was a significant increase in IE incidence among high-risk individuals, a borderline significant increase in moderate-risk individuals, and no change for those at low/unknown risk. Although these data do not establish a cause-effect relationship between AP reduction and IE increase, the fall in AP prescribing in those at high risk is of concern and, coupled with the borderline increase in IE incidence among those at moderate risk, warrants further investigation.
美国心脏协会于 2007 年更新了其预防感染性心内膜炎（IE）的抗生素预防（AP）建议，建议对 IE 中危患者停止 AP，而对高危患者继续 AP。
作者旨在量化 AP 处方和 IE 发病率的任何变化。
在 Truven Health MarketScan 数据库中，通过链接处方和 Medicare 或商业健康保险数据，确定了高危、中危和未知/低危个体，数据时间为 2003 年 5 月至 2015 年 8 月（198522665 受保人年数据）。通过泊松模型分析评估 AP 处方和 IE 发病率。
截至 2015 年 8 月，2007 年的建议变化与中危个体 AP 处方显著下降 64%（95%置信区间[CI]：59%至 68%）和高危个体下降 20%（95% CI：4%至 32%）相关。同期，中危个体 IE 发病率估计增加 75%（95% CI：3%至 200%），高危个体 IE 发病率显著增加 177%（95% CI：66%至 361%）。在未知/低危个体中，AP 处方显著下降 52%（95% CI：46%至 58%），但 IE 发病率无显著增加。
所有 IE 风险组的 AP 处方均下降，尤其是中危个体。同时，高危个体 IE 发病率显著增加，中危个体 IE 发病率增加接近显著，低/未知风险个体无变化。尽管这些数据并未确定 AP 减少与 IE 增加之间的因果关系，但高危个体 AP 处方的下降令人担忧，再加上中危个体 IE 发病率的边缘增加，需要进一步调查。
