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A case‐control study: are urological procedures risk factors for the development of infective endocarditis?
Author(s) -
Mohee Amar R.,
West Robert,
Baig Wazir,
Eardley Ian,
Sandoe Jonathan A.T.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12550
Subject(s) - medicine , odds ratio , infective endocarditis , confidence interval , population , surgery , endocarditis , environmental health
Objective To evaluate the association between urological procedures and the development of infective endocarditis ( IE ), as there are case‐reports linking urological procedures to IE but evidence of a causal relationship is lacking and no major guidelines advise prophylaxis to prevent development of IE during transurethral urological procedures. No case‐control study has been undertaken to examine the relationship between urological procedures and the development of IE . Patients and Methods Retrospective evaluation of the IE database at our institution. The population consisted of patients diagnosed with enterococcal, staphylococcal, S treptococcus bovis ‐group and oral streptococcal IE over a 10‐year period. Possible risk factors for the development of IE , including urological procedures were collected. A case‐control design was used and univariable and multivariable analyses were carried out. Missing data was accounted for using the multiple imputations method. Results We included 384 patients with IE . There was a statistical association between the development of enterococcal IE and preceding urological procedures (odds ratio 8.21, 95% confidence interval 3.54–19.05, P < 0.05). Increasing age and being an intravenous drug user were also associated with enterococcal IE . Haemodialysis and the presence of an intracardiac device were associated with the development of coagulase‐negative staphyloccal IE . Conclusion This is the first study to show a statistical association between urological procedures and the development of IE . The bacteraemia leading to IE may be a result of the urological procedures or a consequence of the underlying urological pathology causing recurrent subclinical bacteraemias.