Knowledge, Compliance and Practice of Antibiotic Endocarditis Prophylaxis of Patients with Congenital Heart Disease

Abstract

The aim of this study was to determine the knowledge, compliance, and practice of antibiotic endocarditis prophylaxis (AEP) for patients with congenital heart disease (CHD) during various diagnostic or therapeutic procedures. Patients (296) and their parents were interrogated during a visit with an 18-question survey pertaining to the practice of AEP. Most patients (91.6%) had acyanotic congenital heart disease, usually preoperative (45.3%), or had high risk of infective endocarditis due to previous endocarditis (2.0%), cyanosis (8.4%), or prosthetic valves (5.4%). Potential sources for failure of AEP were (1) no existence of a wallet card (6.8%), no communication between patient and doctor concerning the potential risk of endocarditis during a visit (13.2%), or no sufficient anamnestic inquiry by the physician before procedures were performed (43.2%). The patients underestimated (4.4%) or had no knowledge of the individual risks of endocarditis (37.5%) or underestimated indication for AEP (11.1%). AEP was often not performed at all (60.5%). Bad dental status with no previous dental therapy (35.5%) and a high rate of caries (17.2%) or gingivitis (7.4%) even in young children was frequent. AEP for patients with CHD has not been sufficiently used because of the patient's, and the physician's failure to take the necessary steps, the cardiac diagnosis, or the dental health status. Alternative strategies in prophylaxis for AEP are discussed here.

Conhecimento dos pais sobre profilaxia de endocardite infecciosa em crianças portadoras de cardiopatias congênitas

“…Many studies conducted in several centers have shown that parental knowledge of the care needed to prevent IE in children with heart disease is lower than expected [9][10][11]13,15,16]. In the present study, only 34% of parents/ caregivers have demonstrated satisfactory knowledge, and only 15 respondents seemed to know what IE was.…”

“…Several studies indicate that parents' knowledge about their children's heart problems is inadequate, as well as the necessary precautions to prevent EI [9][10][11][12][13]. The Brazilian Society of Cardiology has no guidelines for IE prophylaxis and the various departments of pediatric cardiology embraced the AHA recommendations by 2007.…”

Infective endocarditis in congenital heart disease

“…Amoxicillin prophylaxis reduces bacteremia in children after dental procedures from 84% to 33% [85]. Prophylaxis, however, may fail due to patient-related factors (compliance) in up to 40%, physician-related factors (knowledge) in 50%, and ineffective drugs against rare pathogens in 66% [33,38,42,65,68,69,72,73,83,84,88,97,108,116,119,122,137]. Nowadays, bacteremia from daily care activities is judged a far greater risk [134].…”

Knowledge and practices of dentists in preventing infective endocarditis in children

“…Invasive dental procedures have often been regarded as the main cause of infective endocarditis (IE). The prevention of IE has been debated and has remained controversial in the dental profession 1–4 . There is an ongoing debate 5–7 about which dental procedures warrant antibiotic prophylaxis (AP).…”

“…The prevention of IE has been debated and has remained controversial in the dental profession. [1][2][3][4] There is an ongoing debate 5-7 about which dental procedures warrant antibiotic prophylaxis (AP). The latest recommendations stress using AP prior to dental procedures associated with significant bleeding in patients with high and moderate risk of endocarditis.…”