The elegant article by Dr Seto in support of infectious endocarditis (IE) prophylaxis focuses on 4 areas: the severity and importance of IE, the ability to identify patients at risk for IE, the ability to identify procedures likely to cause IE, and the evidence of beneficial effects of IE prophylaxis. I will refer to the population of New York, NY, to demonstrate how Dr Seto's arguments regarding IE prophylaxis support my position.
First, Dr Seto alludes to the epidemiology of IE. Community-acquired IE (for that is what we are addressing when we are discussing IE prophylaxis) is rare. With the epidemiology of IE seeming to be relatively stable over time, the annual incidence of IE associated with oral organisms is no more than 3.5 per 100 000 individuals (roughly 280 cases for all of New York each year).1 With a mortality rate of about 20%, IE probably results in about 56 deaths per year in New York.
Morris AM. Rebuttal. Arch Intern Med. 2007;167(4):333-334. doi:10.1001/archinte.167.4.334