Clinical Research
Infective Endocarditis
Temporal Trends in Infective Endocarditis in the Context of Prophylaxis Guideline Modifications: Three Successive Population-Based Surveys

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Objectives

The goal of this study was to evaluate temporal trends in infective endocarditis (IE) incidence and clinical characteristics after 2002 French IE prophylaxis guideline modifications.

Background

There are limited data on changes in the epidemiology of IE since recent guidelines recommended restricting the indications of antibiotic prophylaxis of IE.

Methods

Three 1-year population-based surveys were conducted in 1991, 1999, and 2008 in 3 French regions totaling 11 million inhabitants age ≥20 years. We prospectively collected IE cases from all medical centers and analyzed age- and sex-standardized IE annual incidence trends.

Results

Overall, 993 expert-validated IE cases were analyzed (323 in 1991; 331 in 1999; and 339 in 2008). IE incidence remained stable over time (95% confidence intervals given in parentheses/brackets): 35 (31 to 39), 33 (30 to 37), and 32 (28 to 35) cases per million in 1991, 1999, and 2008, respectively. Oral streptococci IE incidence did not increase either in the whole patient population (8.1 [6.4 to 10.1], 6.3 [4.8 to 8.1], and 6.3 [4.9 to 8.0] in 1991, 1999, and 2008, respectively) or in patients with pre-existing native valve disease. The increased incidence of Staphylococcus aureus IE (5.2 [3.9 to 6.8], 6.8 [5.3 to 8.6], and 8.2 [6.6 to 10.2]) was not significant in the whole patient population (p = 0.228) but was significant in the subgroup of patients without previously known native valve disease (1.6 [0.9 to 2.7], 3.7 [2.6 to 5.1], and 4.1 [3.0 to 5.6]; p = 0.012).

Conclusions

Scaling down antibiotic prophylaxis indications was not associated with an increased incidence of oral streptococcal IE. A focus on avoidance of S. aureus bacteremia in all patients, including those with no previously known valve disease, will be required to improve IE prevention.

Key Words

epidemiology
infective endocarditis
population-based
prophylaxis
staphylococci

Abbreviation and Acronym

IE
infective endocarditis

Cited by (0)

This work was supported by the following organizations: L'Association Pédagogique Nationale pour l'Enseignement de la Thérapeutique, Société de Pathologie Infectieuse de Langue Française, Société Française de Microbiologie, Société Nationale Française de Médecine Interne, Société de Réanimation de Langue Française, Société Française de Gérontologie, Société Française de Cardiologie, Société Française de Chirurgie Thoracique et Cardiovasculaire, Société Française d'Anesthésie-Réanimation, Fédération Française de Cardiologie, and the Inserm network on infective endocarditis. This work was supported by a research grant from the French Ministry of Health, the support of the Société Française de Cardiologie, the European Society of Clinical Microbiology and Infectious Diseases, and by Novartis Laboratories. The sponsor was the Département à la Recherche Clinique et à l'innovation (French Ministry of Health), Hôpital Universitaire de Besançon. The sponsor supported the research but had no access to the data. Dr. Iung is a consultant for Boehringer-Ingelheim, Bayer, Valtech, Servier, and Abbott; and has received speaker fees from Edwards Lifesciences and Sanofi-Aventis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.