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Incidencia de endocarditis infecciosa en Inglaterra, 2000-13: una tendencia secular, análisis de series temporales
Mark J Dayer1, Simon Jones2, Bernard Prendergast3
1Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, Somerset, UK.
Lancet (London, England)
|December 4, 2014
Resumen
Las recetas de profilaxis con antibióticos disminuyeron significativamente en Inglaterra siguiendo las pautas de NICE. La incidencia de endocarditis infecciosa aumentó notablemente, especialmente en pacientes de alto riesgo, lo que sugiere un vínculo potencial.
Área de la Ciencia:
- Cardiología Cardiología.
- Enfermedades infecciosas Enfermedades infecciosas.
- Salud Pública La salud pública.
Sus antecedentes:
- La profilaxis con antibióticos para la prevención de la endocarditis infecciosa ha sido históricamente una práctica estándar.
- Los recientes cambios en las directrices en los EE.UU. y Europa han reducido las recomendaciones para la profilaxis con antibióticos.
- Las directrices del NICE del Reino Unido (marzo de 2008) recomendaron el cese completo de la profilaxis antibiótica para la prevención de la endocarditis infecciosa.
Objetivo del estudio:
- Para investigar los cambios en la profilaxis de antibióticos que prescriben siguiendo las pautas de NICE.
- Evaluar el impacto en la incidencia de endocarditis infecciosa en Inglaterra.
Principales métodos:
- Estudio retrospectivo de tendencias seculares utilizando análisis de series temporales interrumpidas.
- Análisis de las prescripciones de profilaxis antibiótica desde enero de 2004 hasta marzo de 2013.
- Examen de los datos de alta hospitalaria para los diagnósticos de endocarditis infecciosa desde enero de 2000 hasta marzo de 2013.
Principales resultados:
- Se produjo una disminución sustancial en las recetas de profilaxis antibiótica después de la guía de NICE (10.900 / mes a 2.236 / mes).
- Se observó un aumento significativo en los casos de endocarditis infecciosa a partir de marzo de 2008 (0,11 casos por cada 10 millones de personas por mes).
- En marzo de 2013, se informaron 35 casos mensuales adicionales en comparación con la tendencia histórica, que afectan tanto a las personas de alto y bajo riesgo.
Conclusiones:
- Las recetas para la profilaxis de antibióticos disminuyeron significativamente después de las pautas de NICE de 2008.
- La incidencia de endocarditis infecciosa aumentó significativamente en Inglaterra después de los cambios en las directrices.
- Si bien no se ha establecido la causalidad, los datos sugieren una correlación entre la profilaxis reducida y el aumento de las tasas de endocarditis infecciosa.
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