The invasive surgical procedure infective endocarditis association study (The I-SPIE association study)

Infective endocarditis (IE) is a life-threatening cardiac infection with ~30% one-year mortality.

A near doubling of IE incidence has occurred in England in the last 10-years, but the factors responsible for the increase have yet to be defined.

Previously, national guidelines recommended that individuals at increased IE risk who were undergoing certain invasive-surgical procedures (ISP) should receive pre-procedure antibiotic prophylaxis (AP) to reduce the IE risk. In 2008, however, NICE recommended cessation of this practice. Most ISP are now performed without AP and many of the ISP have increased in frequency.

This could, in part, explain the large increase in IE incidence since 2008. For this to be the case, there would need to be a clear temporal association between ISP and development of IE. This study will use English hospital-admissions data to determine if such a link exists.

A case-crossover design study will be used to identify if there is an increased IE risk in the 3-months immediately following ISP as compared to other time intervals.

The results of this investigation could determine: 1) if AP use should be reconsidered; or 2) whether reassurance about the safety of withholding AP for a non-dental ISP is warranted.