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Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007
Ronak J Naik1, Neil R Patel2, Ming Wang3
11Department of Pediatrics,The University of Tennessee Health Science Center and Le Bonheur Children's Hospital,Memphis,Tennessee,United States of America.
Insights
Pediatric cardiologists show varied practices in prescribing antibiotic prophylaxis for infective endocarditis, with many not exclusively following current guidelines. Optimizing oral hygiene counseling for at-risk patients is also needed.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The American Heart Association updated infective endocarditis prophylaxis guidelines in 2007, narrowing antibiotic use for high-risk cardiac conditions.
- Current practice evaluation is crucial following these guideline modifications.
Purpose of the Study:
- To assess current infective endocarditis prophylaxis practices among pediatric cardiologists.
- To identify variations in antibiotic prescribing for diverse congenital and acquired heart diseases.
Main Methods:
- A web-based, anonymous survey was emailed to pediatric cardiologists.
- The survey focused on antibiotic prophylaxis use in various cardiac conditions and was distributed twice.
Main Results:
- Data from 253 participants revealed inconsistent prophylaxis for conditions like rheumatic heart disease and Fontan palliation.
- Antibiotic prophylaxis use varied widely (44-83%) for indicated conditions; only 44% adhered strictly to guidelines.
- Oral hygiene discussions occurred regularly with only 34% of at-risk patients.
Conclusions:
- Significant heterogeneity exists in pediatric cardiologists' recommendations for infective endocarditis prophylaxis.
- Over half of practitioners (56%) do not exclusively follow current guidelines.
- Enhanced oral health counseling for at-risk patients requires optimization in clinical practice.
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.
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