Incidence of Infective Endocarditis Caused by Viridans Group Streptococci Before and After Publication of the 2007 American Heart Association's Endocarditis Prevention Guidelines

Abstract

Background The American Heart Association (AHA) published updated guidelines for infective endocarditis (IE) prevention in 2007 that markedly restricted the use of antibiotic prophylaxis in certain at-risk patients undergoing dental and other invasive procedures. The incidence of IE due to viridans group streptococci (VGS) in the United States following publication of the 2007 AHA guidelines has not been reported. Methods and Results We performed a population-based review of all definite or possible cases of VGS-IE using the Rochester Epidemiology Project of Olmsted County, Minnesota. Patient demographics and microbiologic data were collected for all VGS-IE cases diagnosed from January 1, 1999 through December 31, 2010. We also examined the Nationwide Inpatient Sample (NIS) hospital discharge database to determine the number of VGS-IE cases included between 1999 and 2009. We identified 22 cases with VGS-IE in Olmsted County over the 12-year study period. Rates of incidence (per 100,000 person-years) during time intervals of 1999–2002, 2003–2006, and 2007–2010, were 3.19 (95% confidence interval [CI], 1.20–5.17), 2.48 (95% CI, 0.85–4.10), and 0.77 (95% CI, 0.00–1.64), respectively (p-value=0.061 from Poisson regression). The number of hospital discharges with a VGS-IE diagnosis in the NIS database during 1999–2002, 2003–2006, and 2007–2009 ranged between 15,318–15,938, 16,214–17,433, and 14,728–15,479, respectively. Conclusions Based on data complete through 2010, there has been no perceivable increase in incidence of VGS-IE in Olmsted County, MN following publication of the 2007 AHA Endocarditis prevention guidelines.

2015 ESC Guidelines for the management of infective endocarditis

“…Na podstawie wyników 2 badań przeprowadzonych w Stanach Zjednoczonych nie wykazano negatywnego wpływu zaniechania profilaktyki antybiotykowej u pacjentów z chorobami własnych zastawek po opublikowaniu wytycznych Amerykańskiego Towarzystwa Kardiologicznego (AHA) w 2007 r. [34,35]. W nowszych analizach danych z baz administracyjnych zanotowano wzrost częstości hospitalizacji z powodu IZW w latach 2000-2011, ale bez istotnych zmian po wprowadzeniu amerykańskich wytycznych w 2007 r. [36].…”

“…Chociaż powyższy rozdział wytycznych dotyczą-cy profilaktyki IZW opiera się na dowodach o niż-szym poziomie wiarygodności, zostały one ostatnio wzmocnione wynikami badań epidemiologicznych, w większości których nie wykazano zwiększonej częstości występowania IZW spowodowanego przez paciorkowce jamy ustnej [33][34][35]. Zastosowanie opisywanych metod profilaktyki przez pacjentów powinno nastąpić w wyniku wspólnego procesu decyzyjnego.…”

Antibiotic prophylaxis for dental procedures

“…Two retrospective studies in the USA 27,28 showed no changes in the rate of infective endocarditis due to viridans streptococci three years after the revision of the guidelines in 2007. A third study found a significant increase in streptococcal infective endocarditis, but it Antibiotic prophylaxis for dental procedures…”

Antimicrobial Drugs

“…Macrolides have little activity against periodontal pathogens, and in recent years their activity against streptococcal species has declined to such a degree that most experts discourage their use in odontogenic infections as well. Desimone et al 9 analyzed 150 cases of infective endocarditis in Olmstead County, Minnesota, that occurred from 1999 through 2010. Of 22 cases attributable to viridans group streptococci,~95% were sensitive to penicillin but only~71% to macrolides.…”

“…As mentioned previously, resistance to macrolides is increasing and any recommendation for their use may be modified in future guidelines. 9 In some cases, a patient may present for treatment having not premedicated. The following is a direct quote from the current American Heart Association guidelines; simply stated, administer the antibiotic regimen and complete the treatment!…”