UK study finds sharp rise in infective endocarditis

Incidence of infective endocarditis in the United Kingdom has increased markedly since 1998, but the increase does not appear to be linked to 2008 guidelines aimed at reducing antibiotic prophylaxis before dental procedures, UK researchers reported yesterday in BMC Medicine.

To measure and model trends in national incidence of infective endocarditis from April 1998 through March 2017, the researchers used data from Hospital Episode Statistics (HES), which contains details of all inpatient admissions to National Health Service (NHS) hospitals in England, and used three different sets of inclusion criteria and a range of regression models to identify the most likely date for a change in trends. They also looked at secondary diagnostic codes in HES data and national laboratory data to identify infective endocarditis caused by oral streptococcal species, which would be more likely to be associated with dental procedures.

The results shows that infective endocarditis incidence increased from 22.2 to 41.3 per million population in 1998 to 42.0 to 67.7 in 2017 depending on inclusion criteria. The most likely dates for a change in incidence trends ranged from September 2001 (uncertainty interval August 2000 to May 2003) to May 2015 (March 1999 to January 2016), depending on inclusion criteria and statistical model used.

For the proportion of infective endocarditis cases associated with streptococci, the most likely change points ranged from October 2008 (March 2006 to April 2010) to August 2015 (September 2013–November 2015), but those associated with oral streptococci decreased in proportion after the change point. Smoothed trends showed no notable changes in trend around the guideline date.

"Although we find no evidence that the withdrawal of dental antibiotic prophylaxis has increased cases of infective endocarditis, we do find that infective endocarditis has continued to increase rapidly in England, with incidence roughly doubling over the 20 years of the study," the authors wrote. "Further research should focus on determining the true cause of this increase."

Apr 2 BMC Med study

Review highlights use of critical antibiotics in veterinary medicine

A new paper published yesterday in the Journal of Antimicrobial Chemotherapy by an international group of veterinarians highlights the lack of valid and effective alternatives for several classes of medically important antibiotics that are commonly used to treat infections in food-producing and companion animals.

In 2018, the World Health Organization (WHO) recommended that drugs classified as highest priority critically important antimicrobials (HP-CIAs) for human medicine not be used for treatment of food-producing animals with clinically diagnosed infectious disease, due to concerns about rising antibiotic resistance, the risk of resistance spreading from animals to humans, and a desire to maintain the effectiveness of these drugs for human infections. The WHO identified five classes of antimicrobials as HP-CIAs: extended-spectrum cephalosporins, macrolides and ketolides, glycopeptides, polymyxins, and quinolones.

But data on how often these drugs are used in livestock production, and what disease they are used to treat, is lacking. To outline the diseases for which HP-CIAs are most commonly used in food-producing (pigs, cattle, and poultry) and companion animals (horses, dogs, and cats), and highlight areas where effective alternatives may be lacking, members of the European Society of Clinical Microbiology and Infectious Diseases Study Group for Veterinary Microbiology reviewed 20 articles and reports identified through a literature review.

The review found that HP-CIAs are most commonly used for enteric and respiratory infections in pigs, cattle, and poultry. The most common indications for dogs and cats are urogenital infections, while horses receive HP-CIAs most frequently for respiratory infections. The review also found that there are no valid and effective alternatives to colistin and macrolides for certain enteric infections in pigs and respiratory pathogens in cattle. In addition, effective, legal, and convenient alternatives are lacking for managing common infections in cats, some enteric and respiratory infections in poultry, and multidrug-resistant infections in all companion animal species.

The authors conclude, "Although the panel of potential alternatives to antimicrobials has grown substantially in recent years, more research is needed to develop and validate effective and sustainable non-antimicrobial strategies, especially for managing the disease conditions identified by this review."

Apr 2 J Antimicrob Chemother abstract