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Original research
Increased risk of infective endocarditis after traumatic skin wound
  1. Hiroyuki Ohbe1,
  2. Masao Iwagami2,3,
  3. Yusuke Sasabuchi4,
  4. Hideo Yasunaga1
  1. 1Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
  2. 2Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
  3. 3Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan
  1. Correspondence to Hiroyuki Ohbe, Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo 113-0033, Japan; hohbey{at}


Objective Current data suggest that a history of traumatic open skin wounds may be a risk factor for infectious endocarditis, with limited evidence. We tested the hypothesis that traumatic skin wound is a risk factor for infectious endocarditis.

Methods Using the Japan Medical Data Center (JMDC) database (4 650 927 people aged 20–64 years, 2012–2018) and the Kumamoto database (493 414 people aged ≥65 years, 2012–2017), we conducted nested case–control and self-controlled case series (SCCS) analyses.

Results In the JMDC database, 544 cases hospitalised for infective endocarditis (IE) were matched with 2091 controls; 2.8% of cases and 0.5% of controls were exposed to traumatic skin wounds in the previous 1–4 weeks, with an adjusted OR of 4.31 (95% CI 1.74 to 10.7). In the Kumamoto database, 4.0% (27/670) of cases and 1.1% (29/2581) of controls were exposed to traumatic skin wounds in the previous 1–4 weeks, with an adjusted OR of 4.15 (95% CI 2.04 to 8.46). In the SCCS, the incidence rate ratios for IE were 2.61 (95% CI 1.67 to 4.09), 1.73 (95% CI 1.01 to 2.94), 1.19 (95% CI 0.63 to 2.27) and 1.52 (95% CI 0.82 to 2.74) for the Kumamoto database and 3.78 (95% CI 2.07 to 6.92), 1.58 (95% CI 0.64 to 3.89), 1.60 (95% CI 0.65 to 3.94) and 1.29 (95% CI 0.47 to 3.53) for the JMDC database at 1–4, 5–8, 9–12 and 13–16 weeks after traumatic skin wound, respectively, compared with the baseline period.

Conclusions This study suggests that traumatic skin wound is a risk factor for IE 1–4 weeks after the wound.

  • endocarditis

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  • Presented at This work was performed at The University of Tokyo and Jichi Medical University.

  • Contributors HO designed the research; YS and HY conducted the research; HO and MI analysed the data; HO, MI and HY wrote the paper; HO is the guarantor of this research. All authors read and approved the final manuscript.

  • Funding This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (grant numbers 19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (grant numbers 17H04141 and JP19K19394).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The datasets analysed during the current study are not publicly available due to contracts with the hospitals providing data to the database.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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