The Association Between Cutaneous Wounds and Infective Endocarditis: A Nationwide Self-Controlled Case Series Study in Taiwan.

Abstract

Background and objectives: We aim to investigate whether disruption of the skin defense in the form of cutaneous wounds may increase the incidence rate (IR) of infective endocarditis (IE) in the general population.

Methods: We performed a retrospective population-based study using Taiwan's National Health Insurance Database from 2013 to 2022. Self-controlled case series (SCCS) was used to investigate the time-sequential association between cutaneous wounds and IE. Adult patients with both cutaneous wounds (exposure) and IE (outcome) in the database were included in the study. Conditional Poisson regression was used to calculate the adjusted IR ratios (aIRRs) of IE during the 4 weeks following wounds to that of the baseline period within the same individuals.

Results: We enrolled 3,241 eligible patients for SCCS analysis. The risks of IE were elevated in the second week (aIRR, 2.16; 95% confidence interval [CI], 1.07-4.35; p value=0.032) after a treated traumatic wound. The risks of IE were elevated in the first (aIRR, 1.56; 95% CI, 1.17-2.09; p value=0.002) and second (aIRR, 1.58; 95% CI, 1.19-2.10; p value=0.002) after a treated non-traumatic wound.

Conclusions: Both traumatic and non-traumatic cutaneous wounds are associated with an increased risk of IE within the first 2 weeks after treatments among the general population in Taiwan. Clinicians should be vigilant for symptoms or signs associated with IE in these patients to avoid delays in diagnosis and treatment.