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Incidence of infective endocarditis in England,2000–13: a secular trend, interrupted time-series analysis

Dayer, M, Jones, S, Prendergast, B, Baddour, LM, Lockhart, PB and Thornhill, MH (2014) Incidence of infective endocarditis in England,2000–13: a secular trend, interrupted time-series analysis Lancet.

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Abstract

Summary Background Antibiotic prophylaxis given before invasive dental procedures in patients at risk of developing infective endocarditis has historically been the focus of infective endocarditis prevention. Recent changes in antibiotic prophylaxis guidelines in the USA and Europe have substantially reduced the number of patients for whom antibiotic prophylaxis is recommended. In the UK, guidelines from the National Institute for Health and Clinical Excellence (NICE) recommended complete cessation of antibiotic prophylaxis for prevention of infective endocarditis in March, 2008. We aimed to investigate changes in the prescribing of antibiotic prophylaxis and the incidence of infective endocarditis since the introduction of these guidelines. Methods We did a retrospective secular trend study, analysed as an interrupted time series, to investigate the eff ect of antibiotic prophylaxis versus no prophylaxis on the incidence of infective endocarditis in England. We analysed data for the prescription of antibiotic prophylaxis from Jan 1, 2004, to March 31, 2013, and hospital discharge episode statistics for patients with a primary diagnosis of infective endocarditis from Jan 1, 2000, to March 31, 2013. We compared the incidence of infective endocarditis before and after the introduction of the NICE guidelines using segmented regression analysis of the interrupted time series. Findings Prescriptions of antibiotic prophylaxis for the prevention of infective endocarditis fell substantially after introduction of the NICE guidance (mean 10 900 prescriptions per month [Jan 1, 2004, to March 31, 2008] vs 2236 prescriptions per month [April 1, 2008, to March 31, 2013], p<0·0001). Starting in March, 2008, the number of cases of infective endocarditis increased signifi cantly above the projected historical trend, by 0·11 cases per 10 million people per month (95% CI 0·05–0·16, p<0·0001). By March, 2013, 35 more cases per month were reported than would have been expected had the previous trend continued. This increase in the incidence of infective endocarditis was signifi cant for both individuals at high risk of infective endocarditis and those at lower risk. Interpretation Although our data do not establish a causal association, prescriptions of antibiotic prophylaxis have fallen substantially and the incidence of infective endocarditis has increased signifi cantly in England since introduction of the 2008 NICE guidelines.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences
Authors :
AuthorsEmailORCID
Dayer, MUNSPECIFIEDUNSPECIFIED
Jones, SUNSPECIFIEDUNSPECIFIED
Prendergast, BUNSPECIFIEDUNSPECIFIED
Baddour, LMUNSPECIFIEDUNSPECIFIED
Lockhart, PBUNSPECIFIEDUNSPECIFIED
Thornhill, MHUNSPECIFIEDUNSPECIFIED
Date : 18 November 2014
Identification Number : 10.1016/S0140-6736(14)62007-9
Related URLs :
Additional Information : Copyright © 2014 Elsevier B.V. except certain content provided by third parties.NOTICE: this is the author’s version of a work that was accepted for publication in Lancet. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Lancet, November 2014, DOI 10.1016/S0140-6736(14)62007-9.
Depositing User : Symplectic Elements
Date Deposited : 02 Dec 2014 18:48
Last Modified : 03 Dec 2014 14:33
URI: http://epubs.surrey.ac.uk/id/eprint/806676

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