title: A case-control study: are urological procedures risk factors for the development of infective endocarditis?
abstract: OBJECTIVE
  To evaluate the association between urological procedures and the development of infective endocarditis (IE), as there are case-reports linking urological procedures to IE but evidence of a causal relationship is lacking and no major guidelines advise prophylaxis to prevent development of IE during transurethral urological procedures. No case-control study has been undertaken to examine the relationship between urological procedures and the development of IE.
  
  
  METHODS
  Retrospective evaluation of the IE database at our institution. The population consisted of patients diagnosed with enterococcal, staphylococcal, Streptococcus bovis-group and oral streptococcal IE over a 10-year period. Possible risk factors for the development of IE, including urological procedures were collected. A case-control design was used and univariable and multivariable analyses were carried out. Missing data was accounted for using the multiple imputations method.
  
  
  RESULTS
  We included 384 patients with IE. There was a statistical association between the development of enterococcal IE and preceding urological procedures (odds ratio 8.21, 95% confidence interval 3.54-19.05, P < 0.05). Increasing age and being an intravenous drug user were also associated with enterococcal IE. Haemodialysis and the presence of an intracardiac device were associated with the development of coagulase-negative staphyloccal IE.
  
  
  CONCLUSIONS
  This is the first study to show a statistical association between urological procedures and the development of IE. The bacteraemia leading to IE may be a result of the urological procedures or a consequence of the underlying urological pathology causing recurrent subclinical bacteraemias.
authors.affiliation: Department of Urology, The Salford Royal NHS Trust, Salford, UK.
authors.forename: Amar R
authors.initials: AR
authors.lastname: Mohee
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.forename: Wazir
authors.initials: W
authors.lastname: Baig
authors.forename: Ian
authors.initials: I
authors.lastname: Eardley
authors.forename: Jonathan A T
authors.initials: JA
authors.lastname: Sandoe
mesh_terms: D000367:Age Factors; D016022:Case-Control Studies; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D013290:Streptococcal Infections / Q000453:epidemiology / Q000209:etiology; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*
keywords: antibiotics prophylaxis; guidelines; infective endocarditis; morbidity; transurethral procedures; urological procedures