Incidence of Infective Endocarditis due to Viridans Group Streptococci Before and After Publication of the 2007 American Heart Association's Endocarditis Prevention Guidelines
Background—The American Heart Association (AHA) published updated guidelines for infective endocarditis (IE) prevention in 2007 that markedly restricted the use of antibiotic prophylaxis in certain at-risk patients undergoing dental and other invasive procedures. The incidence of IE due to viridans group streptococci (VGS) in the United States following publication of the 2007 AHA guidelines has not been reported.
Methods and Results—We performed a population-based review of all definite or possible cases of VGS-IE using the Rochester Epidemiology Project of Olmsted County, Minnesota. Patient demographics and microbiologic data were collected for all VGS-IE cases diagnosed from January 1, 1999 through December 31, 2010. We also examined the Nationwide Inpatient Sample (NIS) hospital discharge database to determine the number of VGS-IE cases included between 1999 and 2009. We identified 22 cases with VGS-IE in Olmsted County over the 12-year study period. Rates of incidence (per 100,000 person-years) during time intervals of 1999-2002, 2003-2006, and 2007-2010, were 3.19 (95% confidence interval [CI], 1.20-5.17), 2.48 (95% CI, 0.85-4.10), and 0.77 (95% CI, 0.00-1.64), respectively (p-value=0.061 from Poisson regression). The number of hospital discharges with a VGS-IE diagnosis in the NIS database during 1999-2002, 2003-2006, and 2007-2009 ranged between 15,318-15,938, 16,214-17,433, and 14,728-15,479, respectively.
Conclusions—Based on data complete through 2010, there has been no perceivable increase in incidence of VGS-IE in Olmsted County, MN following publication of the 2007 AHA Endocarditis prevention guidelines.
- Received January 24, 2012.
- Accepted April 30, 2012.
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