Practice Variation in Infective Endocarditis Prophylaxis for Pediatric and Congenital Heart Disease Patients with...

Recommendations for infective endocarditis (IE) prophylaxis have narrowed substantially over the past two decades. Current guidance from the American Heart Association and the European Society of Cardiology is largely derived from adult populations and may not account for the unique anatomic substrates and lifelong device exposure encountered in pediatric and congenital heart disease (CHD) patients with cardiac implantable electronic devices (CIEDs). To evaluate contemporary practice patterns regarding IE prophylaxis among clinicians caring for pediatric and CHD patients with CIEDs and to describe clinician-reported experience with device-associated IE. A cross-sectional, web-based survey was distributed to members of the Pediatric and Congenital Electrophysiology Society (PACES). The survey was sent to approximately 200 members, with 67 responses received (34%). Survey questions addressed prophylaxis practices for dental, gastrointestinal, genitourinary, and respiratory procedures. Respondents were also asked to report prior clinical experience with IE in patients with CIEDs. Responses were analyzed using descriptive statistics. Sixty-seven clinicians completed the survey. Substantial variation in prophylaxis practices was observed across clinical scenarios. Most respondents reported practice patterns consistent with guideline recommendations for CIED patients with structurally normal hearts. However, nearly all respondents (92%) reported recommending long-term antibiotic prophylaxis for CIED patients with complex or high-risk repaired congenital heart disease. Respondents collectively reported experience with 35 cases of CIED-associated IE, of which 34 involved transvenous lead systems, with the majority occurring more than six months after device implantation. Most reported cases of IE were not associated with a preceding invasive procedure. Practice patterns for IE prophylaxis in pediatric and congenital patients with CIEDs vary considerably among clinicians. These findings highlight uncertainty regarding the applicability of adult-derived IE prophylaxis guidelines to pediatric and congenital populations and underscore the need for studies to better define IE risk and guide pediatric-specific recommendations.