Infective endocarditis: we could (and should) do better
| Autor: | Bernard Prendergast, Paul Scully, Simon Woldman |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Population ageing
medicine.medical_specialty 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine valve disease surgery Internal medicine Epidemiology medicine Humans Endocarditis 030212 general & internal medicine Antibiotic prophylaxis business.industry Incidence (epidemiology) Endocarditis Bacterial medicine.disease Natural history Valvular Heart Disease Infective endocarditis Diagnosis code Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2020-317671 |
| Popis: | Infective endocarditis (ie, the infection of a native or prosthetic heart valve, the endocardium or implanted cardiac device1) is a clinical chameleon whose epidemiology and natural history are in constant evolution, reflecting the complex interaction between an ageing population, elusive microorganisms, evolving patterns of healthcare, available therapies and the application of aggressive surgery. Despite overall advances in treatment, there is no consistent signal of falling incidence and clinical outcomes remain poor. IE is uncommon with a generally accepted overall annual incidence of 3–10 cases per 100 000 people.1 However, recent data indicate that this incidence has increased significantly in England where IE admissions (primary ICD-10 diagnostic code I33) remained stable between 1998–1999 (26.6 cases/million) and 2009–2010 (26.9 cases/million) but rose dramatically (by 86%) to 50.0 cases/million in 2018–2019 (figure 1).2 While some of this increase may partly relate to recommendations by the National Institute for Health and Care Excellence in 2008 regarding the cessation of antibiotic prophylaxis in at-risk individuals undergoing selected dental and other invasive medical procedures,3 this association cannot be confirmed in the absence of microbiological data. Indeed, multiple contributory factors are likely, including (A) an ageing population, (B) increased use of both intra-cardiac (including permanent pacemakers, implantable cardioverter-defibrillators, surgical and transcatheter heart valves) and vascular devices (including those used for chronic haemodialysis), (C) epidemic levels of opioid addiction and associated injection drug use, (D) emergence of staphylococci and enterococci (neither of which are targeted by current antibiotic prophylaxis strategies) as more common causative organisms, and (E) greater clinical awareness of IE. Nevertheless, these findings are disturbing and contrast with reports of falling incidence in the USA4 and falling or more modest increases in Europe.5 European guidelines … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|