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Prophylaxis for infective endocarditis: let's end the debate

2014; Elsevier BV; Volume: 385; Issue: 9974 Linguagem: Inglês

10.1016/s0140-6736(14)62121-8

ISSN

1474-547X

Autores

Xavier Duval, Bruno Hoen,

Tópico(s)

Cardiac Valve Diseases and Treatments

Resumo

Despite continued progress in the diagnosis and treatment of infective endocarditis, in-hospital mortality associated with this disease remains at about 20%, essentially unchanged for the past two decades. 1 Hoen B Duval X Infective endocarditis. N Engl J Med. 2013; 368: 1425-1433 Crossref PubMed Scopus (333) Google Scholar Therefore, increased efforts to reduce the incidence of infective endocarditis are needed. Since 2002, the policy for antibiotic prophylaxis against infective endocarditis has changed substantially in favour of restricted indications, with two different strategies: that in the UK, where the 2008 guidelines 2 NICEProphylaxis against infective endocarditis. National Institute for Health and Clinical Excellence, 2008http://www.nice.org.uk/CG064 Google Scholar , 3 Stokes T Richey R Wray D Prophylaxis against infective endocarditis: summary of NICE guidance. Heart. 2008; 94: 930-931 Crossref PubMed Scopus (37) Google Scholar from the National Institute of Health and Clinical Excellence (NICE) recommended that antibiotic prophylaxis be abandoned in any patient for any procedure; and the strategy adopted elsewhere (and endorsed by guidelines from the American College of Cardiology, American Heart Association [AHA], and European Society of Cardiology [ESC]), 4 Habib G Hoen B Tornos P et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009; 30: 2369-2413 Crossref PubMed Scopus (1616) Google Scholar , 5 Wilson W Taubert KA Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007; 116: 1736-1754 Crossref PubMed Scopus (1926) Google Scholar in which antibiotic prophylaxis is to be reserved for individuals with valve disease at high risk of infective endocarditis (ie, with a prosthetic valve, history of infective endocarditis, or cyanotic congenital heart disease) who undergo an orodental procedure with a high risk of bacteraemia. In both strategies, oral hygiene is strongly promoted. Since 2008, all studies that have analysed the changes in infective endocarditis epidemiology after guidelines partly 6 Duval X Delahaye F Alla F et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol. 2012; 59: 1968-1976 Summary Full Text Full Text PDF PubMed Scopus (285) Google Scholar , 7 Pasquali SK He X Mohamad Z et al. Trends in endocarditis hospitalizations at US children's hospitals: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines. Am Heart J. 2012; 163: 894-899 Summary Full Text Full Text PDF PubMed Scopus (109) Google Scholar or totally 8 Thornhill MH Dayer MJ Forde JM et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ. 2011; 342: d2392 Crossref PubMed Scopus (192) Google Scholar restricted the indications for antibiotic prophylaxis showed no increased incidence of infective endocarditis, including the subgroup caused by oral streptococci. One of these studies 8 Thornhill MH Dayer MJ Forde JM et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ. 2011; 342: d2392 Crossref PubMed Scopus (192) Google Scholar was done in the UK and analysed the 3 year period after the NICE guidelines were issued. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysisAlthough our data do not establish a causal association, prescriptions of antibiotic prophylaxis have fallen substantially and the incidence of infective endocarditis has increased significantly in England since introduction of the 2008 NICE guidelines. Full-Text PDF Infective endocarditis and antibiotic prophylaxisWe read with interest the Article by Mark Dayer and colleagues1 and the Comment by Xavier Duval and Bruno Hoen,2 and agree with several of their interpretations. We provide an update to our previous analysis of elderly (>65 years) Medicare beneficiaries (figure). Consistent with our previous analysis,3 we observed a continued decline in the rate of admissions to hospital with infective endocarditis among elderly Medicare beneficiaries. Full-Text PDF

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