A new study published in the American Heart Journal highlights the current epidemiology of infective endocarditis (IE) in patients with congenital heart disease (CHD) in the UK. The findings indicate that there is a substantial burden of IE in patients with CHD in spite of ongoing efforts in disease prevention.
Researchers analysed cases of IE in children and adults with CHD from tertiary congenital centres that were prospectively recorded as part of the UK National Institute for Cardiovascular Outcomes Research (NICOR) National CHD Audit between April 2008 and March 2016.
One out of 15 patients (6.7%) with IE and CHD died before discharge from the hospital. Dental procedure preceded 11 per cent of IE episodes, dental extraction being the most common procedure. Non-dental invasive procedures preceded 27.4 per cent of IE episodes, cardiac catheterisation, venous line placement and gastrointestinal/genitourinary (GI/GU) surgery being the most common procedures. In spite of recommendations from NICE, antibiotic prophylaxis was provided in only 39 per cent of dental procedures and 50 per cent of GI/GU surgeries.
Streptococci were the most common causative organisms, responsible for 40 per cent of cases. Staphylococcal infection (HR, 2.0; 95% CI, 1.0-3.9; P=.036) and underlying atrioventricular septal defect (HR, 3.0; 95% CI, 1.2-7.6; P=.017) were risk factors associated with in-hospital mortality.
The authors said: "Assessing whether aggressive, early surgical treatment of CHD patients with staphylococcal disease improves outcome is an important question for future research."