Department of Medicine and Department of Biostatistics and Epidemiology, London Health Sciences Centre, (P.G.), Western University, ON, Canada.
Institute for Clinical Evaluative Sciences (ICES) (P.G., K.M.B.J., L.L., S.Z.S.), Western University, ON, Canada.
Circulation. 2019 Jul 16;140(3):170-180. doi: 10.1161/CIRCULATIONAHA.118.037657. Epub 2019 Apr 26.
In 2007, the American Heart Association recommended antibiotic prophylaxis for the prevention of infective endocarditis (IE) for only the highest-risk patients. Whether this change affected the use of antibiotic prophylaxis and the incidence of IE is unclear.
IE-related hospitalizations were identified from 2002 to 2014 among all adults and those at high and moderate risk for IE, stratified by age. Prescriptions for antibiotic prophylaxis were obtained from the Ontario Drug Benefit database for adults ≥65 years of age. Outcomes were antibiotic prophylaxis prescription rates and incidence of IE-related hospitalization. Trends in patient and pathogen characteristics were analyzed. Time series analyses were performed with segmented regression and change-point analyses.
Prescriptions for antibiotic prophylaxis decreased substantially in the moderate-risk cohort after the guideline revision (mean quarterly prescriptions, 30 680 versus 17 954 [level change, -6,481; P=0.0004] per 1 million population) with a minimal, yet significant, decrease followed by a slow increase in the high-risk group. There were 7551 IE-related hospitalizations among 6884 adults ≥18 years of age. Among adults ≥65 years of age, the mean IE rate increased from 872 to 1385 and 229 to 283 per 1 million population at risk per quarter in the high- and moderate-risk groups, respectively. Change-point analyses indicated that this increase occurred in the second half of 2010 in adults ≥65 years of age, 3 years after the American Heart Association guideline revision. Staphylococcus aureus and streptococcal species accounted for 30.3% and 26.4% of all IE, with a decrease in streptococcal infections over time.
Antibiotic prophylaxis decreased significantly in the moderate-risk group with minimal change in the high-risk group after the American Heart Association guideline revision in 2007. However, IE-related hospitalizations increased among both high- and moderate-risk patients 3 years after the revision. Our study provides support for the cessation of antibiotic prophylaxis in the moderate-risk population.
2007 年，美国心脏协会建议仅对最高危患者预防感染性心内膜炎（IE）使用抗生素预防。这种变化是否影响抗生素预防的使用和 IE 的发生率尚不清楚。
在所有成年人以及 IE 高危和中危人群中，从 2002 年到 2014 年确定与 IE 相关的住院病例，按年龄分层。从安大略省药物福利数据库中获取≥65 岁成年人的抗生素预防处方。研究结果为抗生素预防处方率和 IE 相关住院率。分析患者和病原体特征的趋势。采用分段回归和变化点分析进行时间序列分析。
指南修订后，中危人群的抗生素预防处方显著减少（平均每季度处方数，高危人群从 30680 降至 17954 [每 100 万人水平变化，-6481；P=0.0004]），高危人群中略有减少，随后缓慢增加。在≥18 岁的 6884 名成年人中，共有 7551 例 IE 相关住院病例。在≥65 岁的成年人中，高危和中危人群每 100 万人的 IE 发病率分别从每季度 872 例和 1385 例增加到 1385 例和 229 例。变化点分析表明，这种增加发生在 2010 年下半年，即美国心脏协会指南修订后的 3 年。金黄色葡萄球菌和链球菌占所有 IE 的 30.3%和 26.4%，链球菌感染随时间减少。
2007 年美国心脏协会指南修订后，中危人群的抗生素预防显著减少，高危人群变化不大。然而，修订后 3 年，高危和中危患者的 IE 相关住院人数均有所增加。本研究为停止中危人群的抗生素预防提供了支持。
