Incidence of infective endocarditis before and after the guideline modification regarding a more restrictive use of prophylactic antibiotics therapy in the USA and Europe.

Infective endocarditis (IE) is a potentially life-threatening disease. Regardless the improvements in IE management, it remains associated with high mortality and severe complications. Staphylococci and streptococci account for 80% of all IE cases. Prevention of IE by appropriate administration of antibiotics before procedures with potential bacteremia in selected patients is recommended according to recent and current guidelines. However, recent studies, have questioned the efficacy of antimicrobial prophylaxis in special situations and in some patient-groups. As a consequence, the guideline of the French working group on IE in 2002, the American Heart Association (AHA) guideline in 2007, the National Institute for Health and Clinical Excellence (NICE) guideline for Great Britain in 2008, and the European Society of Cardiology (ESC) guideline in 2009 restricted the recommendation for antibiotic prophylaxis to high-risk patients only, and only for certain invasive procedures. IE incidence increased in the USA, England and Germany in the last two decades. Study results for the USA, England, France, and Germany were not consistent regarding the influence of the revised guidelines for IE prophylaxis on the IE incidence. Although some study results pointed to an increase of the IE cases after the changes in the guideline recommendations, a final appraisal regarding the impact of the revised guideline recommendations on IE incidence could not be drawn at this time point due to the heterogeneous study results.