Author + information
- Received February 14, 2018
- Revision received March 12, 2018
- Accepted March 19, 2018
- Published online June 11, 2018.
- Imre Janszky, MD, PhDa,b,∗ (, )@NTNU@karolinskainst,
- Katalin Gémes, PhDc,
- Staffan Ahnve, MD, PhDc,
- Hilmir Asgeirsson, MD, PhDd,e and
- Jette Möller, PhDc
- aDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- bRegional Center for Health Care Improvement, St. Olavs Hospital, Trondheim, Norway
- cDepartment of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- dDepartment of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- eUnit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- ↵∗Address for correspondence:
Dr. Imre Janszky, Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Håkon Jarls gate 11, NO-7489 Trondheim, Norway.
Background Various invasive medical procedures might induce bacteremia and, hence, act as triggers for infective endocarditis. However, empirical data in humans on the potential dangers of invasive medical procedures in this regard are very sparse. Due to lack of sufficient data, it is currently debated whether the risk for endocarditis with medical procedures is substantial or rather negligible.
Objectives The purpose of this nationwide case-crossover study was to quantify the excess risk for infective endocarditis in association with invasive medical and surgical procedures.
Methods The authors identified all adult patients treated for endocarditis in hospitals in Sweden between January 1, 1998, and December 31, 2011. The authors applied a case-crossover design and compared the occurrence of invasive medical procedures 12 weeks before endocarditis with a corresponding 12-week time period exactly 1 year earlier. The authors considered all invasive nondental medical procedures except for those that are likely to be undertaken due to endocarditis or sepsis or due to infections that could possibly lead to endocarditis.
Results The authors identified 7,013 cases of infective endocarditis during the study period. Among others, several cardiovascular procedures, especially coronary artery bypass grafting; procedures of the skin and management of wounds; transfusion; dialysis; bone marrow puncture; and some endoscopies, particularly bronchoscopy, were strongly associated with an increased risk for infective endocarditis.
Conclusions This study suggests that several invasive nondental medical procedures are associated with a markedly increased risk for infective endocarditis.
Grants were provided from the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology and from the Swedish Research Council. The funding sources had no role in the study design; collection, analysis, and interpretation of data; writing of the report, or decision to submit the paper for publication. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 14, 2018.
- Revision received March 12, 2018.
- Accepted March 19, 2018.
- 2018 American College of Cardiology Foundation
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