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Antibiotic Prophylaxis for Infective Endocarditis: A Survey of Practice Among Pediatric Cardiology Providers
Whitney Horsley1, Shardha Srinivasan2, John S Hokanson2
1Mid-Valley Children's Clinic, Samaritan Health Services, Albany, OR, USA.
Insights
Pediatric cardiologists show varied antibiotic prophylaxis prescribing practices for infective endocarditis, even for high-risk patients. Guidelines are inconsistently applied for predisposing cardiac conditions and procedures.
Area of Science:
- Cardiology
- Infectious Disease
- Pediatrics
Background:
- The 2007 American Heart Association (AHA) guidelines restricted antibiotic prophylaxis (AP) for infective endocarditis (IE).
- This impacted recommendations for patients with predisposing cardiac conditions (PCC).
Purpose of the Study:
- To survey pediatric cardiologists on their AP recommendations for various PCC and procedures.
- To assess adherence to 2007 AHA guidelines for IE prophylaxis.
Main Methods:
- Survey of 173 respondents from the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery (AAP SOCCS).
- Analysis of AP prescribing practices based on PCC and procedures, following 2007 AHA guidelines.
Main Results:
- AP prescribing rates for high-risk PCC meeting AHA criteria ranged from 70.5-89.8%.
- For PCC not meeting AHA criteria, prescribing rates varied widely (<1% to 29.5%).
- Variability in AP prescribing was also observed for procedures in patients with high-risk PCC.
Conclusions:
- Significant variability exists in pediatric cardiologists' AP prescribing practices.
- Inconsistent application of 2007 AHA guidelines for IE prophylaxis is evident.
- Further clarification or updated guidelines may be needed for AP in pediatric cardiology.
Abstract:
The 2007 American Heart Association (AHA) guidelines limited antibiotic prophylaxis (AP) for infective endocarditis (IE) to fewer patients with predisposing cardiac conditions (PCC). We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery (AAP SOCCS) on their recommendations for AP for a number of PCC and procedures. We report on those 173 respondents who follow the 2007 AHA guidelines. AP rates for high-risk PCCs clearly meeting AHA criteria ranged from 70.5-89.8%. Conversely, for PCCs which did not meet AHA criteria, prescribing rates varied from <1% to 29.5%. PCC for which AP indication was unclear per guidelines, AP rates similarly varied from 9.9-39.8%. Similar variability is noted in AP for various procedures in setting of high-risk PCC. There is variability in AP prescribing practices among pediatric cardiologists based on both underlying PCC and noncardiac procedures in the setting of underlying cardiac disease.
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