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Does Secondary Antibiotic Prophylaxis Improve Clinical Outcomes in Adult Rheumatic Heart Disease Patients Post-Valve
Abdulrazaq S Al-Jazairi1,2,3, Ahlam M Althobaiti2, Josef Marek4
1Clinical Trials Transformation Initiative (CTTI) Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
World Journal for Pediatric & Congenital Heart Surgery
|December 19, 2022
Summary
Secondary antibiotic prophylaxis for rheumatic heart disease (RHD) patients after valve replacement does not improve survival or reduce hospitalizations. Continuous antibiotic use showed no significant clinical benefit in this patient group.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Outcomes Research
Background:
- Rheumatic heart disease (RHD) necessitates continuous antibiotic prophylaxis for secondary prevention of recurrent rheumatic fever.
- The efficacy of antibiotic prophylaxis in severe RHD patients post-heart valve replacement remains unclear.
- This study investigates the impact of antibiotic prophylaxis on clinical outcomes in RHD patients after valve replacement surgery.
Purpose of the Study:
- To assess the relationship between antibiotic prophylaxis and clinical outcomes in RHD patients following heart valve replacement.
- To evaluate the effect of secondary antibiotic prophylaxis on mortality, reoperation rates, and valve-related hospitalizations.
- To determine if continuous antibiotic use improves outcomes in severe RHD patients post-valve surgery.
Main Methods:
- Retrospective comparison of adult RHD patients undergoing heart valve replacement between 1990-2014.
- Utilized propensity score matching to compare outcomes between patients receiving and not receiving secondary antibiotic prophylaxis.
- Analyzed overall survival, valve-related hospitalization-independent survival, and redo valve surgery-independent survival at 10-year follow-up.
Main Results:
- A total of 1094 RHD patients were analyzed, with 18% receiving antibiotic prophylaxis.
- Propensity score matching revealed no significant differences in 10-year overall survival between prophylaxis and non-prophylaxis groups (97% vs. 95%, P=.7).
- No significant differences were observed in valve-related hospitalization-independent survival (81% vs. 72%, P=.25) or redo valve surgery-independent survival (75% vs. 76%, P=.41).
Conclusions:
- Secondary antibiotic prophylaxis in adult RHD patients after heart valve replacement is not associated with improved clinical outcomes.
- The findings suggest that continuous antibiotic prophylaxis may not offer significant benefits for mortality or morbidity in this specific patient population.
- Further research may be warranted to explore alternative strategies for secondary prevention in RHD patients post-valve surgery.
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