Infective Endocarditis Hospitalizations and Antibiotic Prophylaxis Rates Before and After the 2007 American Heart Association Guidelines Revision.
Circulation. 2019 Apr 26;:
Authors: Garg P, Ko DT, Bray Jenkyn KM, Li L, Shariff SZ
BACKGROUND: In 2007, American Heart Association (AHA) recommended antibiotic prophylaxis for the prevention of infective endocarditis (IE) for only the highest-risk patients. Whether this change impacted the use of antibiotic prophylaxis and the incidence of IE is unclear.
METHODS: IE-related hospitalizations were identified from 2002-2014 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 and older. 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.
RESULTS: Prescriptions for antibiotic prophylaxis decreased substantially in moderate-risk cohort following guideline revision (mean quarterly prescriptions 30,680 vs. 17,954 [level change -6,481, p=0.0004] per million population) with minimal, yet significant, decrease, followed by a slow increase in high-risk group. There were 7551 IE-related hospitalizations among 6884 all adults aged 18 and older. Among adults 65+, mean IE rate increased from 872 to 1385 and 229 to 283 per million population at risk, per quarter, in the high and moderate-risk groups, respectively. Change point analyses indicated that this increase occurred in 2nd-half of 2010 in adults 65 and older, 3 years after the AHA guideline revision. S. aureus and streptococcal species accounted for 30.3% and 26.4% of all IE, with a decrease in streptococcal infections over time.
CONCLUSIONS: Antibiotic prophylaxis decreased significantly in the moderate-risk group with minimal change in high-risk group following AHA guideline revision in 2007. However, IE-related hospitalizations have increased among both high and moderate-risk patients, and 3 years after the revision. Our study provides support for the cessation of antibiotic prophylaxis in the moderate-risk population.
PMID: 31023074 [PubMed - as supplied by publisher]