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Trends in infective endocarditis hospitalisations at United States children’s hospitals from 2003 to 2014: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines

Published online by Cambridge University Press:  15 July 2016

Katherine E. Bates ,
Matthew Hall ,
Samir S. Shah ,
Kevin D. Hill  and
Sara K. Pasquali
Katherine E. Bates*
Affiliation:
Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Matthew Hall
Affiliation:
Children’s Hospital Association, Overland Park, Kansas, United States of America
Samir S. Shah
Affiliation:
Division of Hospital Medicine and Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Kevin D. Hill
Affiliation:
Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina, United States of America
Sara K. Pasquali
Affiliation:
Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
*
Correspondence to: K. E. Bates, MD, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, 1540 E. Hospital Drive, Ann Arbor, MI 48109, United States of America. Tel: 734 936 2537; Fax: 734 936 4628; E-mail: kebates@med.umich.edu
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Abstract

Objective

National organisations in several countries have recently released more restrictive guidelines for infective endocarditis prophylaxis, including the American Heart Association 2007 guidelines. Initial studies demonstrated no change in infective endocarditis rates over time; however, a recent United Kingdom study suggested an increase; current paediatric trends are unknown.

Methods

Children (<18 years) hospitalised with infective endocarditis at 29 centres participating in the Pediatric Health Information Systems Database from 2003 to 2014 were eligible for inclusion. Our primary analysis focussed on infective endocarditis most directly related to the change in guidelines and included community-acquired cases in those >5 years of age. Interrupted time series analysis was used to evaluate rates over time indexed to total hospitalisations.

Results

A total of 841 cases were identified. The median age was 13 years (interquartile range 9–15 years). In the pre-guideline period, there was a slight increase in the rate of infective endocarditis by 0.13 cases/10,000 hospitalisations per semi-annual period. In the post-guideline period, the rate of infective endocarditis increased by 0.12 cases/10,000 hospitalisations per semi-annual period. There was no significant difference in the rate of change in the pre- versus post-guidelines period (p=0.895). Secondary analyses in children >5 years of age with CHD and in children hospitalised with any type of infective endocarditis at any age revealed similar results.

Conclusions

We found no significant change in infective endocarditis hospitalisation rates associated with revised prophylaxis guidelines over 11 years across 29 United States children’s hospitals.

Keywords

Endocarditisantibiotic prophylaxispaediatrics
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 4 , May 2017 , pp. 686 - 690
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Copyright
© Cambridge University Press 2016 

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