Traumatic skin wounds may be risk factor for infective endocarditis
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Traumatic skin wounds may be a risk factor for infective endocarditis in the weeks after wound development, according to findings published in Heart.
“There have been some case reports of infective endocarditis following trauma episodes. Recently, two case series studies have suggested that trauma may be a risk factor for infective endocarditis,” Hiroyuki Ohbe, MD, MPH, PhD student in the department of clinical epidemiology and health economics at the University of Tokyo School of Public Health, and colleagues wrote. “A finding of a significant association between traumatic skin wounds and infective endocarditis in the present study would mean that more studies are needed to verify whether antibiotic prophylaxis (currently not recommended for traumatic skin wounds, even in patients with a high risk of infective endocarditis) may be able to reduce the risk of infective endocarditis following traumatic skin wounds.”
In nested case-control and self-controlled analyses, researchers evaluated the association between traumatic skin wounds and development of infective endocarditis in participants from the Japan Medical Data Center (JMDC) database and the Kumamoto database. Researchers further matched 544 infective endocarditis hospitalizations with 2,091 controls from the JMDC database and 670 infective endocarditis hospitalizations with 2,581 controls from the Kumamoto database. Short-term wound analysis occurred at 1 to 4 weeks after traumatic skin wound, 5 to 8 weeks after traumatic skin wound, 9 to 12 weeks after traumatic skin wound and 13 to 16 weeks after traumatic skin wound.
Study results from the JMDC database showed 2.8% of patients with infective endocarditis and 0.5% of controls were exposed to traumatic skin wounds between weeks 1 and 4 (adjusted OR = 4.31; 95% CI, 1.47-10.7). Further self-controlled analyses at each studied time point yielded infective endocarditis incidence rate ratios of 3.78 (95% CI, 2.07-6.92) for 1 to 4 weeks, 1.58 (95% CI, 0.64-3.89) for 5 to 8 weeks, 1.6 (95% CI, 0.65-3.94) for 9 to 12 weeks and 1.29 (95% CI, 0.47-3.53) for 13 to 16 weeks compared with the baseline period.
Study results from the Kumamoto database showed traumatic skin wound exposure in 4% of patients with infective endocarditis and 1.1% of controls between 1 and 4 weeks (aOR = 4.15; 95% CI, 2.04-8.46). Self-controlled analyses yielded infective endocarditis incidence rate ratios of 2.61 (95% CI, 1.67-4.09) for 1 to 4 weeks, 1.73 (95% CI, 1.01-2.94) for 5 to 8 weeks, 1.19 (95% CI, 0.63-2.27) for 9 to 12 weeks and 1.52 (95% CI, 0.82-2.74) for 13 to 16 weeks compared with the baseline period.
“It is generally difficult to prove causality between traumatic skin wounds and infective endocarditis in clinical or epidemiological studies. However, our findings of an increased risk of infective endocarditis in the 1 to 4 weeks after traumatic skin wound events can be supported by the biological mechanisms suggested in previous basic studies,” Ohbe and colleagues concluded. “Further studies are warranted to examine whether antibiotic prophylaxis could reduce the risk of infective endocarditis following traumatic skin wounds.”
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