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Endocardite infectieuse : du risque à la prévention, de la cohorte clinique à la base médico-administrative

Abstract : Infective endocarditis (IE) is a rare disease, difficult to diagnose, with high morbidity and mortality rates. Main involved microorganisms are Staphylococcus aureus and oral streptococci. Clinical research to improve IE risk assessment and IE prevention strategy requires the establishment of large clinical cohort studies and the use of medico-administrative databases. Using data from the multicenter French prospective VIRSTA cohort study on 2 008 adult patients (pts) with Staphylococcus aureus bloodstream infection (SAB), we have developed and validated an IE prediction score taking into account pts’ background and initial SAB characteristics. Pts with a score ≤ 2 had a very low risk of IE (1%, negative predictive value [95% CI] = 99% [98;99]) compared to those with a score ≥ 3, at higher risk of IE (17%) for whom an echocardiography is needed. Using the medico-administrative SNIIRAM database, we assessed the relation between invasive dental procedures (IDP) and oral streptococcal IE in a population-based cohort study of 138 876 pts with prosthetic heart valves and a case-crossover study including 648 pts with oral streptococcal IE. Incidence rate of oral streptococcal IE [95% CI] was 93.7 per 100 000 PA [82.4;104.9] without significant increase within the 3 months following IDP (RR = 1.25 [0.82;1.82]). In the case-crossover analysis, exposure to IDP was more frequent in the 3 months preceding IE than during previous control periods (5.1% vs. 3.2%, OR: 1.66 [1.05;2.63]). IDP may contribute to the development of oral streptococcal IE in pts with prosthetic heart valves.The quality of data from VIRSTA study combined with the power of SNIIRAM database made possible the identification of IE at-risk SAB pts and the evaluation of the IDP contribution in oral streptococcal IE.
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Submitted on : Tuesday, April 30, 2019 - 2:55:06 PM
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Sarah Tubiana. Endocardite infectieuse : du risque à la prévention, de la cohorte clinique à la base médico-administrative. Santé publique et épidémiologie. Université Sorbonne Paris Cité, 2018. Français. ⟨NNT : 2018USPCC019⟩. ⟨tel-02115796⟩



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