12 May Rising Number Of Heart Infections Due To Staphylococcus Bacteria

MedicalResearch.com Interview with:
J L Mehta, MD, PhD
Professor of Medicine and Physiology and Biophysics
Stebbins Chair in Cardiology
University of Arkansas for Medical Sciences
Little Rock, AR 72205

Medical Research: What is the background for this study? What are the main findings?

Dr. Mehta: In 2007, ACC/AHA published new guidelines regarding infective endocarditis (IE) prevention. This guideline drastically differed from the way we practiced and prescribed antibiotics to our patients when they undergo surgery or any other procedure like dental procedure, endoscopy, etc. to prevent infective endocarditis. As a result of these guideline, antibiotic use is now being restricted to only a small number of patients who have cardiac conditions that puts them at very high risk for adverse outcomes from IE. However, there is paucity of data on IE trends in the community following such a major change in practice. Therefore evaluated the trend in incidence of infective endocarditis and their outcomes before and after the advent of new guideline.

Our study has several important findings.

First, there has been a steady increase in the incidence of infective endocarditis hospitalizations over the last decade in the US. However, the incidence of IE pre- and post-inception of new antibiotic prophylaxis guidelines is not significantly different. In parallel to these findings, the rate of valve replacement for infective endocarditis did not change after the release of new guidelines in 2007.

Secondly, the increase in IE incidence was seen across all types of pathogens- Staphylococcus, Streptococcus, gram negative bacteria and fungi. The major offender involved in IE in the United States is Staphylococcus.

Finally, the rate of Streptococcus infective endocarditis related hospitalization increased significantly following the release of new guideline in the US, while Staphylococcus IE hospitalizations although on rise, did not increase significantly following the 2007 ACC/AHA guideline update.

Medical Research: What should clinicians and patients take away from your report?

Dr. Mehta: The take home messages from our study is that the incidence of infective endocarditis in the country is steadily rising causing more hospitalization, healthcare expenditure and morbidity. The reason behind this seems multifactorial including factors pertaining to healthcare providers (increasing device implants, surgical procedures), patients (increasing proportion of intravenous drug users, patient with cardiac problem, immunosuppresed, hemodialysis patient) and the flora (increasing prevalence of MRSA in the community/hospitals). While the new guideline has advocated more rational use of antibiotic, this doesn’t seem to have decreased the rising burden of the disease. We have seen in our study that Staphylococcus has remained the major microbe responsible. We believe this data will help develop more targeted prevention strategy to prevent the rising incidence of this disease.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mehta: Some of the areas worth exploring in this field include use of hospital microbiological data specific antibiotic usage in IE prevention, use of alternate strategy like antiplatelet agent for IE prevention, impact of controlled substance monitoring and its impact on infective endocarditis, ongoing monitoring of impact of prevention guideline and finally cost effectiveness analysis of the prevention strategy.

Citation:

MedicalResearch.com Interview with: J L Mehta, MD, PhD (2015). Rising Number Of Heart Infections Due To Staphylococcus Bacteria 

Last Updated on May 12, 2015 by Marie Benz MD FAAD