Infective endocarditis: prosthetic heart valves and surgery: antibiotic prophylaxis reduced the risk.

Clinical bottom line (level 4)

  1. Antibiotic prophylaxis following an invasive procedure reduced the risk of infective endocarditis (NNT = 68 at 2 weeks) in patients with prosthetic heart valves.
Horstkotte et al: European Heart Journal 1987; 8: 379-381
Expires July 2003

The study

Case-control study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Europe

533 patients (aged ?, ?% male) prosthetic valve patients who had undergone procedures regarded as requiring endocarditis prophylaxis
Cases: 229 patients (% male, mean age ): received a prophylactic antibiotic regime
Controls: 304 patients (% male, mean age ): did not receive any antibiotic regime


Outcomes studied:

The evidence

  • infective endocarditis:
    • CER 6 (7.97%)
    • EER 0 (0.00%)
    • RRR 100%
    • ARR 1.97% (0.41% to 3.54%)
    • NNT 51 (28 to 240)
  • All six patients who developed infective endocarditis had to be re-operated upon for periprosthetic dehiscence in four cases and in two others for septic embolism and prosthetic valve malfunction due to interference with the valve occluder by vegetations. One patient died perioperatively.
  • Two further cases of infective endocarditis occurred in patients from the experimental group 8 and 13 weeks following oropharyngeal surgery.

Citation

  1. Horstkotte , et al: Contribution for choosing the optimal prophylaxis of bacterial endocarditis. European Heart Journal 1987; 8: 379-381
Search Terms: endocarditis and prophylaxis
Contributor: Sumit Dhingra, Carl Heneghan and Chris Ball, July 2000
Reviewer:

Clinical Question.
Patient invasive procedure
Intervention or Exposure antibiotic prophylaxis
Outcome infective endocarditis