Preprocedure Prophylaxis Against Endocarditis Among United States Pediatric Cardiologists

Abstract

This study aimed to determine current practices regarding prophylaxis against infective endocarditis among pediatric cardiologists in the United States 5 years after publication of the most recent American Heart Association (AHA) recommendations. A descriptive, analytical, cross-sectional study was conducted from June 2012 to November 2012 in the format of an anonymous self-administered e-mailed questionnaire among pediatric cardiologists across the United States. The questionnaire inquired about demographic information of cardiologists and their current practices of prescribing preprocedure antibiotic prophylaxis against endocarditis to patients with specific preexisting cardiac conditions. Descriptive analyses were done in percentages. Frequency and exploratory statistical analyses were done by the Chi-square method. Of the 980 cardiologists invited, 221 (23 %) responded to the survey. The findings showed that pediatric cardiologists generally follow the AHA guidelines. The most common cardiac conditions in which antibiotics were administered despite AHA guidelines not requiring prophylaxis were rheumatic heart disease with aortic insufficiency, transposition of the great vessels after the Mustard procedure, bicuspid aortic valve with severe aortic stenosis, cardiac transplantation without valvar disease, and bicuspid aortic valve with severe aortic insufficiency. More experienced pediatric cardiologists were significantly more likely to administer prophylaxis to certain patients than their less experienced peers. Many pediatric cardiologists in the United States continue to administer preprocedure antibiotic prophylaxis against endocarditis even when not recommended to do so per the 2007 AHA guidelines. With certain lesions, highly experienced pediatric cardiologists are more likely to administer prophylaxis than their less experienced counterparts.

Physicians’ knowledge and practice attitudes toward infective endocarditis antibiotic prophylaxis guidelines in Saudi Arabia

“…There was also a higher D score with respondents who are consultants versus nonconsultants, aged >40 years versus <40 years, and with experience of >10 years; however, none of these demographic features were statistically significant. Patel et al [14] reported similar findings that highly experienced pediatric cardiologists compared with their less experienced counterparts continue to administer preprocedural AP against IE even when it is not recommended.…”

Antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions: French cardiologists' implementation of current guidelines

“…However, in some studies, the residual IE risk of some repaired CHDs appeared variously appreciated by specialized cardiologists such as perimembranous ventricular septal defect with no residual shunt or corrected tetralogy of Fallot with no residual shunt, inducing overprescription of IE AP [15][16][17]. Surprisingly, some cardiologists were less likely to recommend IE AP for patients at high risk for IE, mainly because some palliated cyanotic CHD cases are classified as being at high risk of IE by some authors [15] and at low risk for IE by others [16], such as Fontan palliation. However, our questionnaire was not intended to investigate such conditions.…”

“…However, to date no data have been produced for a population of general cardiologists. Only very specific data on pediatric cardiologists or congenital heart disease (CHD) specialists regarding the compliance with the 2007 AHA guidelines [14] are available [15][16][17]. All of them highlighted the correct identification of PCCs at high risk of IE by the cardiologic populations surveyed but all of them underlined IE AP overprescription for PCCs at moderate risk of IE that no longer require IE AP or for some PCCs with a low risk for IE with no indication for IE AP.…”

Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics

“…The primary antibiotic prophylaxis recommendations for placement of non-valvular cardiovascular devices advice that: "Because of the low incidence of infection for many of the devices, evidencebased data have not been collected that prove efficacy." Despite these recommendations, several human cardiologists and institutions do not follow the published guidelines and do administer prophylactic antibiotics (Weber et al, 2008;Shanson, 2010;Patel et al, 2014;BehjatiArdakani et al, 2015;Gillett et al, 2015).…”