International guideline changes and the incidence of infective endocarditis: a systematic review

Abstract

The objective of this study was to determine the impact on incident infective endocarditis (IE) of guideline recommendations to restrict indications for antibiotic prophylaxis. We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. PubMed and EMBASE databases were searched for articles published between 2007 and 2015 using mesh terms relevant to the research question. Included were English language articles published after 2009 that provided estimates of IE incidence before-and-after major international guideline changes. Seven studies were identified: 1 conducted in France, 4 in the USA and 2 in the UK. Only 1 study reported an increase in the rate of incident IE following guideline modification, and the remainder showed no change in upward (2 studies) or downward (4 studies) incidence trends. Study quality was generally poor for answering the question posed in this review, with serious risk of bias related to diagnostic ascertainment and unavailability of population risk data to adjust the incidence estimates. Moreover, the studies were often small, and relevant bacteriological data were not always available. Only 2 reported changes in antibiotic prescriptions, but these data were not linked to health records making it impossible to determine causal relations to changes in incident IE. The studies in this review were heterogenous in their design and variably limited by study size, duration of follow-up, diagnostic ascertainment, and absence of relevant prescription and bacteriological data. The studies were inconsistent in their conclusions and it remains uncertain what, if any, has been the impact of antibiotic prophylaxis guideline changes on the incidence of IE.

Clinical and Microbiological Characteristics of Infective Endocarditis at a Cardiac Center in Saudi Arabia

“…Data regarding clinical and microbiological features of IE in the Kingdom of Saudi Arabia (KSA) are limited, as one report estimated the rate of definitive IE in KSA to be about 15 cases per 100,000 admissions/discharges [ 8 ], while internationally the estimated incidence is 3–10 cases per 100,000 per year [ 9 ]. The aim of this retrospective case series was to describe the clinical, microbiological and echocardiographic characteristics of patients with IE over a five-year period at Prince Sultan Cardiac Center (PSCC), a governmental hospital in the Central region of KSA, located in the capital city Riyadh.…”

Surgery for acute infective endocarditis: epidemiological data from a Spanish nationwide hospital-based registry†

“…The prognosis has not improved despite the improvements in the diagnosis and treatment, and nowadays, mortality rate remains high in spite of recent medical and surgical advances. Mortality is 15-50% depending on the series [7,[9][10][11], and this is probably due to an increase in microbiological resistance, comorbidities and association with healthcare [1,2,12].…”

Improving medical care and prevention in adults with congenital heart disease—reflections on a global problem—part II: infective endocarditis, pulmonary hypertension, pulmonary arterial hypertension and aortopathy

“…In international comparison, however, the new recommendations and strategy changes are not uniform (22). It must be emphasized that the new recommendations are viewed controversial in the area of CHD and that at least some experienced clinicians see a wider spectrum of indications.…”