Infective endocarditis: risk factors included recent infectious episodes or skin wounds.

Clinical bottom line (level 3b)

  1. Patients were at increased risk of developing infective endocarditis if they had
    • an infectious episode in the last 3 months (NNH = 1600 at 3 months)
    • skin wounds in the last 3 months (NNH = 1600 at 3 months)
  2. Patients who had dental, medical or surgical procedures were not clearly at increased risk of developing infective endocarditis.
Lacassin et al: European Heart Journal 1995; 16: 1968-1974
Expires October 2003

The study

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

Setting: three regions, France

342 patients (aged mean 58 years, 66% male)

Excluded if
  • aged < 15
  • valve replacement within previous year
  • prematurely dead
  • Coxiella burnetii infective endocarditis
  • intravenous drug users


    • Cases: 171 patients (66% male, mean age 58): diagnosed using von Reyn criteria as definite, probable or possible infective endocarditis
    Controls: 171 patients (66% male, mean age 58): matched for age, sex and underlying cardiac condition

    Factors studied:
  • medical, surgical or dental procedures, infectious episodes and skin wounds within previous 3 months, diabetes mellitus, alcohol and tobacco consumption


    • Factors summarised:
  • infectious episode
  • skin wound


    • Multivariate regression analysis performed on risk factors.

    Outcomes studied:
  • infective endocarditis

    • The evidence

    Patient expected event rate for infective endocarditis: 0.021%
    risk factor for
    infective endocarditis     		adjusted OR
    (95% CI)    		 NNH
    (95% CI)
    infectious episode 3.9
    (2.1 to 7.3)     		1600
    (760 to 4300)
    skin wound 3.9
    (1.6 to 9.6)     		1600
    (560 to 7900)

    Comments

    1. Medical, surgical and dental procedures were not found to be associated with an increased risk of infective endocarditis.
    2. There was no clear difference in the rate of infective endocarditis between patients given prophylactic antibiotics and those who were not.
    3. Patient expected event rate taken from the incidence in six US counties.

    Citation

    1. Lacassin F, Hoen B, Leport C, et al: procedures associated with infective endocarditis in adults: a case control study. European Heart Journal 1995; 16: 1968-1974
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient healthy
    Intervention or Exposure dental, surgical, medical procedures
    Outcome infective endocarditis