Abstract 8718: Increase in the Incidence of Bacterial Endocarditis Concurrent with Changes in Guidelines
Introduction: Changes in guidelines for the prevention of bacterial endocarditis (SBE) have recommended progressively less intensive antibiotic prophylaxis. However, the effect of the changes on the incidence of SBE has not been studied.
Methods: Using the Myocardial Data Acquisition System (MIDAS), a statewide database including all admissions with cardiovascular disease in all non-federal hospitals in NJ, we identified 24,161 SBE admissions (ICD codes 421.0, 421.1, 421.9, 424.9) from 1994 to 2007. Age and gender adjusted incidence was computed using the 2000 Census.
Results: SBE incidence showed an increase beginning in 2001. However, when SBE incidence as a reason for admission was examined (SBE as primary diagnosis, n=7,618), there was no appreciable change during the 14 year study period. On the contrary, by fitting a piecewise linear model, admissions with SBE as a secondary diagnosis in patients admitted for another condition (n=18,476) exhibited a significant increase between 2005 and 2007 (slope 115±10, p=0.0016) but no significant change between 2001 and 2005 (slope 11±5, p=0.0701) or after 2007 (slope 9±22, p=0.7660). The reason for admission of patients admitted for SBE as a secondary diagnosis included diseases of the circulatory system (31.5%), complications of surgery or fracture (11.6%), infections and parasitic diseases (15%) and diseases of the respiratory and digestive system (16.2%), other (25.7%). Sensitivity analysis indicated similar increases in the incidence of SBE as a secondary diagnosis regardless of the primary reason for admission.
Conclusions: There has been an increase in age and gender adjusted SBE incidence in NJ under the study period beginning in 2002. This is due only to an increase of SBE as a secondary diagnosis, while SBE as a reason for admission remained stable. Whether this is causally related to the changes in the guidelines needs further investigation.
- © 2011 by American Heart Association, Inc.