Temporal association between invasive procedures and infective endocarditis.

Antibiotic prophylaxis has been recommended for patients at increased risk of infective endocarditis (IE) undergoing specific invasive procedures (IPs) despite a lack of data supporting its use. Therefore, antibiotic prophylaxis recommendations ceased in the mid-2000s for all but those at high IE risk undergoing invasive dental procedures. We aimed to quantify any association between IPs and IE. All 14 731 IE hospital admissions in England between April 2010 and March 2016 were identified from national admissions data, and medical records were searched for IP performed during the 15-month period before IE admission. We compared the incidence of IP during the 3 months immediately before IE admission (case period) with the incidence during the preceding 12 months (control period) to determine whether the odds of developing IE were increased in the 3 months after certain IP. The odds of IE were increased following permanent pacemaker and defibrillator implantation (OR 1.54, 95% CI 1.27 to 1.85, p<0.001), extractions/surgical tooth removal (OR 2.14, 95% CI 1.22 to 3.76, p=0.047), upper (OR 1.58, 95% CI 1.34 to 1.85, p<0.001) and lower gastrointestinal endoscopy (OR 1.66, 95% CI 1.35 to 2.04, p<0.001) and bone marrow biopsy (OR 1.76, 95% CI 1.16 to 2.69, p=0.039). Using an alternative analysis, bronchoscopy (OR 1.33, 95% CI 1.06 to 1.68, p=0.049) and blood transfusions/red cell/plasma exchange (OR 1.2, 95% CI 1.07 to 1.35, p=0.012) were also associated with IE. This study identifies a significant association between specific IPs (permanent pacemaker and defibrillator implantation, dental extraction, gastrointestinal endoscopy and bronchoscopy) and subsequent IE that warrants re-evaluation of current antibiotic prophylaxis recommendations to prevent IE in high IE risk individuals.

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© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: MHT, AC, RC, TS, ECL, MB, VF and JN all received salary support from the British Heart Foundation (Project Grant PG/20/10410) for this study. MHT, PL and JN report other grant support from the National Institutes for Health (USA) or the National Institute for Health Research (UK). BDP reports unrestricted educational and research grants from Edwards Lifesciences, and personal speaker/consultancy fees from Medtronic, Abbott, Microport, Anteris and Edwards Lifesciences. LB reports consulting for Boston Scientific and Roivant Sciences, and royalty payments from UpToDate, Inc. MD reports payment for expert testimony from Bevan Brittan, honoraria for presentations and support for attending meetings from Biotronik. JN reports being chair of the REPHILL trial data monitoring committee from (National Institute for Health and Care Research (NIHR)), chair of research commissioning panels for COVID research (CSO Scotland), member of the UKRI-DHSC COVID-19 Vaccine trial commissioning panel and member of the NIHR commissioning panel for emergency care procedures research.