title: Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys.
abstract: OBJECTIVE
  The goal of this study was to evaluate temporal trends in infective endocarditis (IE) incidence and clinical characteristics after 2002 French IE prophylaxis guideline modifications.
  
  
  BACKGROUND
  There are limited data on changes in the epidemiology of IE since recent guidelines recommended restricting the indications of antibiotic prophylaxis of IE.
  
  
  METHODS
  Three 1-year population-based surveys were conducted in 1991, 1999, and 2008 in 3 French regions totaling 11 million inhabitants age ≥20 years. We prospectively collected IE cases from all medical centers and analyzed age- and sex-standardized IE annual incidence trends.
  
  
  RESULTS
  Overall, 993 expert-validated IE cases were analyzed (323 in 1991; 331 in 1999; and 339 in 2008). IE incidence remained stable over time (95% confidence intervals given in parentheses/brackets): 35 (31 to 39), 33 (30 to 37), and 32 (28 to 35) cases per million in 1991, 1999, and 2008, respectively. Oral streptococci IE incidence did not increase either in the whole patient population (8.1 [6.4 to 10.1], 6.3 [4.8 to 8.1], and 6.3 [4.9 to 8.0] in 1991, 1999, and 2008, respectively) or in patients with pre-existing native valve disease. The increased incidence of Staphylococcus aureus IE (5.2 [3.9 to 6.8], 6.8 [5.3 to 8.6], and 8.2 [6.6 to 10.2]) was not significant in the whole patient population (p = 0.228) but was significant in the subgroup of patients without previously known native valve disease (1.6 [0.9 to 2.7], 3.7 [2.6 to 5.1], and 4.1 [3.0 to 5.6]; p = 0.012).
  
  
  CONCLUSIONS
  Scaling down antibiotic prophylaxis indications was not associated with an increased incidence of oral streptococcal IE. A focus on avoidance of S. aureus bacteremia in all patients, including those with no previously known valve disease, will be required to improve IE prevention.
authors.affiliation: Inserm CIC 007, AP-HP, Hôpital Universitaire Bichat, Paris, France. xavier.duval@bch.aphp.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Obadia
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.forename: Thanh
authors.initials: T
authors.lastname: Doco-Lecompte
authors.forename: Marie
authors.initials: M
authors.lastname: Celard
authors.forename: Claire
authors.initials: C
authors.lastname: Poyart
authors.forename: Christophe
authors.initials: C
authors.lastname: Strady
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.forename: Michelle
authors.initials: M
authors.lastname: Bes
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cambau
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Christine
authors.initials: C
authors.lastname: Selton-Suty
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
mesh_terms: D000328:Adult; D017677:Age Distribution; D019072:Antibiotic Prophylaxis / Q000592:standards / Q000639:trends*; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D055815:Young Adult