Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association's endocarditis prevention guidelines.
BACKGROUND
The American Heart Association 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 caused by viridans group streptococci (VGS) in the United States after publication of the 2007 American Heart Association guidelines has not been reported.


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 microbiological data were collected for all VGS-IE cases diagnosed from January 1, 1999, through December 31, 2010. We also examined the Nationwide Inpatient Sample 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, 1.20-5.17), 2.48 (95% confidence interval, 0.85-4.10), and 0.77 (95% confidence interval, 0.00-1.64), respectively (P=0.061 from Poisson regression). The number of hospital discharges with a VGS-IE diagnosis in the Nationwide Inpatient Sample database during 1999-2002, 2003-2006, and 2007-2009 ranged between 15 318 to 15 938, 16 214 to 17 433, and 14 728 to 15 479, respectively.


CONCLUSIONS
On the basis of data complete through 2010, there has been no perceivable increase in the incidence of VGS-IE in Olmsted County, Minnesota, since the publication of the 2007 American Heart Association endocarditis prevention guidelines.
Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. desimone.daniel@mayo.edu
Daniel C
DC
Desimone
Imad M
IM
Tleyjeh
Daniel D
DD
Correa de Sa
Nandan S
NS
Anavekar
Brian D
BD
Lahr
Muhammad R
MR
Sohail
James M
JM
Steckelberg
Walter R
WR
Wilson
Larry M
LM
Baddour
D000572:American Heart Association; D004696:Endocarditis / Q000453:epidemiology* / Q000517:prevention & control; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic / Q000592:standards*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D034363:Viridans Streptococci