Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-31T10:03:16.601Z Has data issue: false hasContentIssue false
  • English
  • Français

Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

Published online by Cambridge University Press:  30 December 2015

Ronak J. Naik ,
Neil R. Patel ,
Ming Wang  and
Nishant C. Shah Open the ORCID record for Nishant C. Shah [Opens in a new window]
Ronak J. Naik
Affiliation:
Department of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Neil R. Patel
Affiliation:
Icahn School of Medicine at Mount Sinai, Center for Advanced Medicine, New York, New York, United States of America
Ming Wang
Affiliation:
Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
Nishant C. Shah*
Affiliation:
Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
*
Correspondence to: N. C. Shah, Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States of America. Tel: 001-717-531-2050; Fax: 001-717-531-2052; E-mail: nshah@hmc.psu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists.

Methods

A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice.

Results

Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis.

Conclusion

Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

Keywords

Infective endocarditiscongenital heart diseasepaediatric cardiology
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1176 - 1182
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Knirsch, W, Haas, NA, Uhlemann, F, Dietz, K, Lange, PE. Clinical course and complications of infective endocarditis in patients growing up with congenital heart disease. Int J Cardiol 2005; 101: 285–291.CrossRefGoogle ScholarPubMed
2. Niwa, K, Nakazawa, M, Tateno, S, Yoshinaga, M, Terai, M. Infective endocarditis in congenital heart disease: Japanese national collaboration study. Heart 2005; 91: 795–800.Google Scholar
3. Wilson, W, Taubert, KA, Gewitz, M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736–1754.CrossRefGoogle Scholar
4. Dajani, AS, Taubert, KA, Wilson, W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1997; 277: 1794–1801.CrossRefGoogle ScholarPubMed
5. Pharis, CS, Conway, J, Warren, AE, Bullock, A, Mackie, AS. The impact of 2007 infective endocarditis prophylaxis guidelines on the practice of congenital heart disease specialists. Am Heart J 2011; 161: 123–129.Google Scholar
6. Gould, FK, Elliott, TS, Foweraker, J, et al. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006; 57: 1035–1042.Google Scholar
7. Richey, R, Wray, D, Stokes, T, Guideline Development Group. Prophylaxis against infective endocarditis: summary of NICE guidance. BMJ 2008; 336: 770–771.Google Scholar
8. Habib, G, Hoen, B, Tornos, P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30: 2369–2413.Google Scholar
9. Thornhill, MH, Dayer, MJ, Forde, JM, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ 2011; 342: d2392.Google Scholar
10. Desimone, DC, Tleyjeh, IM, Correa de Sa, DD, et al. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association’s endocarditis prevention guidelines. Circulation 2012; 126: 60–64.Google Scholar
11. Rogers, AM, Schiller, NB. Impact of the first nine months of revised infective endocarditis prophylaxis guidelines at a university hospital: so far so good. J Am Soc Echocardiogr 2008; 21: 775.CrossRefGoogle Scholar
12. Duval, X, Delahaye, F, Alla, F, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol 2012; 59: 1968–1976.Google Scholar
13. Brennan, JM, Edwards, FH, Zhao, Y, et al. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database. Circulation 2013; 127: 1647–1655.Google Scholar
14. Breymann, T, Blanz, U, Wojtalik, MA, et al. European Contegra multicentre study: 7-year results after 165 valved bovine jugular vein graft implantations. Thorac Cardiovasc Surg 2009; 57: 257–269.CrossRefGoogle ScholarPubMed
15. McElhinney, DB, Benson, LN, Eicken, A, Kreutzer, J, Padera, RF, Zahn, EM. Infective endocarditis after transcatheter pulmonary valve replacement using the Melody valve: combined results of 3 prospective North American and European studies. Circ Cardiovasc Interv 2013; 6: 292–300.CrossRefGoogle ScholarPubMed
16. Griffin, MR, Wilson, WR, Edwards, WD, O’Fallon, WM, Kurland, LT. Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981. JAMA 1985; 254: 1199–1202.Google Scholar
17. Tleyjeh, IM, Steckelberg, JM, Murad, HS, et al. Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. JAMA 2005; 293: 3022–3028.Google Scholar
18. Strom, BL, Abrutyn, E, Berlin, JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med 1998; 129: 761–769.Google Scholar
19. Lockhart, PB, Brennan, MT, Sasser, HC, Fox, PC, Paster, BJ, Bahrani-Mougeot, FK. Bacteremia associated with toothbrushing and dental extraction. Circulation 2008; 117: 3118–3125.Google Scholar
20. Lockhart, PB, Brennan, MT, Thornhill, M, et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc 2009; 140: 1238–1244.Google Scholar
21. Balmer, R, Bu’Lock, FA. The experiences with oral health and dental prevention of children with congenital heart disease. Cardiol Young 2003; 13: 439–443.Google Scholar